Active NPI
Shaza Basbar Dafalla
- Pediatric Dentistry
- Louisville, KY
National Provider Identifier
1326526211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 1178
- Practice address
- 3934 Dutchmans LN
Louisville, KY 40207-4702 - Phone
- (502) 897-0625
- Fax
- (502) 618-4514
- NPI assigned
- Aug 1, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10659 | KY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 1178 | KY | Primary |
Addresses
Primary practice location
3934 Dutchmans LN
Louisville, KY 40207-4702
Mailing address
98 C Michael Davenport Blvd
Frankfort, KY 40601-4333
Phone (502) 223-7186
Other practice location 1
98 C Michael Davenport Blvd
Frankfort, KY 40601-4333
Phone (502) 223-7186
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210722003870 | KY | Order and Referring Only - Dentist | 3779986112 |
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": "1533081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688860800000",
"number": "1326526211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98 C MICHAEL DAVENPORT BLVD",
"city": "FRANKFORT",
"state": "KY",
"postal_code": "406014333",
"telephone_number": "502-223-7186",
"fax_number": "502-996-8338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3934 DUTCHMANS LN",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074702",
"telephone_number": "502-897-0625",
"fax_number": "502-618-4514"
}
],
"practiceLocations": [
{
"address_1": "98 C Michael Davenport Blvd",
"address_purpose": "LOCATION",
"city": "Frankfort",
"state": "KY",
"postal_code": "406014333",
"country_code": "US",
"telephone_number": "502-223-7186",
"fax_number": "502-996-8338",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAFALLA",
"first_name": "SHAZA",
"middle_name": "BASBAR",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-01",
"last_updated": "2023-07-09",
"certification_date": "2023-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10659",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "KY",
"license": "1178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.