Individual
MR. SHAHROKH SHABAHANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MS,PHD
Contact information
Practice address
17260 BEAR VALLEY RD STE 108, VICTORVILLE, CA 92395-7778
(760) 951-4646
(760) 951-4647
Mailing address
17260 BEAR VALLEY RD STE 108, VICTORVILLE, CA 92395-7778
(760) 951-4646
(760) 951-4647
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
35778
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35778
STATE LIC. #
CA
Enumeration date
03/06/2007
Last updated
07/08/2007
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