Individual
DR. SHAZA BASBAR DAFALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3934 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 897-0625
(502) 618-4514
Mailing address
98 C MICHAEL DAVENPORT BLVD, FRANKFORT, KY 40601-4333
(502) 223-7186
(502) 996-8338
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10659
KY
1223P0221X
Pediatric Dentistry
Primary
1178
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/01/2018
Last updated
07/09/2023
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