Provider Demographics
NPI:1023794450
Name:SHAHEEN, BASANT (DDS)
Entity type:Individual
Prefix:DR
First Name:BASANT
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 TERRITORIAL RD APT 331
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1591
Mailing Address - Country:US
Mailing Address - Phone:203-640-6036
Mailing Address - Fax:
Practice Address - Street 1:6437 BROOKLYN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2143
Practice Address - Country:US
Practice Address - Phone:763-531-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist