Provider Demographics
NPI:1730707944
Name:SHAHROUR, ANNA EENAS (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:EENAS
Last Name:SHAHROUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4050
Mailing Address - Country:US
Mailing Address - Phone:216-251-8826
Mailing Address - Fax:
Practice Address - Street 1:3736 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4050
Practice Address - Country:US
Practice Address - Phone:216-251-8826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25507122300000X
FLDRPM2193122300000X
OH30.026649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN25507OtherFLORIDA BOARD OF DENTISTRY
OH30.026649OtherOHIO STATE DENTAL BOARD