Provider Demographics
NPI:1174650543
Name:IMANI, SHIRIN SHAHINFAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:SHAHINFAR
Last Name:IMANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:SHIRIN
Other - Middle Name:SHAHINFAR
Other - Last Name:IMANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:675 MARINERS ISLAND BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-577-1988
Mailing Address - Fax:650-577-0835
Practice Address - Street 1:675 MARINERS ISLAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-577-1988
Practice Address - Fax:650-577-0835
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice