1457409179 NPI number — DR. TAREK SHABANY D.D.S.

Table of content: DR. TAREK SHABANY D.D.S. (NPI 1457409179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457409179 NPI number — DR. TAREK SHABANY D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHABANY
Provider First Name:
TAREK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457409179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 1ST ST
Provider Second Line Business Mailing Address:
#1708
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-468-1226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 FIRST ST
Provider Second Line Business Practice Location Address:
DENTAL CLINIC, BLDG 20
Provider Business Practice Location Address City Name:
HOLLOMAN AFB
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88330-8006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-572-3742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)