Provider Demographics
NPI:1548960248
Name:ABUANZA, SHAIMAA
Entity type:Individual
Prefix:
First Name:SHAIMAA
Middle Name:
Last Name:ABUANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5818
Mailing Address - Country:US
Mailing Address - Phone:202-937-9389
Mailing Address - Fax:
Practice Address - Street 1:7810 FM 1960 RD E STE 105
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2252
Practice Address - Country:US
Practice Address - Phone:281-852-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7810122300000X
TX40081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist