Provider Demographics
NPI:1023156775
Name:NABIPOUR, SHAHRAM (DDS, MSD)
Entity type:Individual
Prefix:MR
First Name:SHAHRAM
Middle Name:
Last Name:NABIPOUR
Suffix:
Gender:M
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 1:121 W 92ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7583
Mailing Address - Country:US
Mailing Address - Phone:415-310-2848
Mailing Address - Fax:
Practice Address - Street 1:121 W 92ND ST APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7583
Practice Address - Country:US
Practice Address - Phone:415-310-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics