Individual
SHABNAM SEYEDZADEH SABOUNCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3223 N BROAD ST, PHILADELPHIA, PA 19140-5007
(215) 707-2871
Mailing address
3223 N BROAD ST, PHILADELPHIA, PA 19140-5007
(215) 707-2871
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401418630
VA
1223X2210X
Orofacial Pain Dentistry
Primary
RFD000064
PA
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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