Individual
SHIRIN YASREBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2015 E EDGEWOOD DR, LAKELAND, FL 33803
(863) 667-9000
(863) 665-4368
Mailing address
2015 E EDGEWOOD DR, LAKELAND, FL 33803
(863) 667-9000
(863) 665-4368
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
CO12434
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69205
BLUE CROSS BLUE SHIELD
FL
01
—
732758
UNITED CONCORDIA
FL
Enumeration date
08/04/2006
Last updated
07/08/2007
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