Individual
MS. MONDANA NICOLE SHAMSAZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
500 N ESTRELLA PKWY STE B1, GOODYEAR, AZ 85338-4136
(623) 688-5408
Mailing address
15260 W MCDOWELL RD, GOODYEAR, AZ 85395-2530
(623) 207-7838
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D011727
AZ
1223G0001X
General Practice Dentistry
16999
MD
1223G0001X
General Practice Dentistry
D011727
AZ
Other
Enumeration date
08/22/2019
Last updated
07/03/2024
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