Provider Demographics
NPI:1588989321
Name:SHAFIEE, ROXANNA R (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:R
Last Name:SHAFIEE
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CAMPUS DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-757-9490
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:SUITE 212
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-757-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics