Individual provider Active NPI

Sima Shakiba, DMD

  • Dentist
  • Saint Louis, MO
National Provider Identifier
1285244368
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2020022335 Issued in MO
Practice address
4414 N Florissant Ave
Saint Louis, MO 63107-1812
Phone
(314) 814-8700
Fax
(314) 814-8593
NPI assigned
Aug 4, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2020022335 MO Primary

Addresses

Primary practice location

4414 N Florissant Ave
Saint Louis, MO 63107-1812

Mailing address

1717 Biddle St
Saint Louis, MO 63106-3454
Phone (314) 814-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200902000381 MO Order and Referring Only - DentistPractitioner - Dentist 4082031216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1285244368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 BIDDLE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631063454",
            "telephone_number": "314-814-8700",
            "fax_number": "314-814-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 N FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631071812",
            "telephone_number": "314-814-8700",
            "fax_number": "314-814-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKIBA",
        "first_name": "SIMA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2020022335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.