Shahram Fazilat, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE00010790 Issued in WA

Practice address

1307 NE 78TH St
Suite B13
Vancouver, WA 98665-9670

Phone

(360) 574-0900

Fax

(360) 574-6338

NPI assigned

Oct 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Urgent Dental Care LLC

  • Dentist
  • Vancouver, WA
  • NPI 1932334539
  NPD (past)

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1437347457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 NW 12TH AVE",
            "address_2": "APT#519",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 NE 78TH ST",
            "address_2": "SUITE B13",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986659670",
            "telephone_number": "360-574-0900",
            "fax_number": "360-574-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZILAT",
        "first_name": "SHAHRAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE00010790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antoinette Faustino
• Katelyn Favela
• Lee Mitchell Faver, PHD ABPP
• Kenneth Favour, M.D.
• Jameson Fay, DPT
• Aylar Fazlzadeh
• Huong Le Fearington, O.D.
• Russell Glenn Fearington
• Amber Rae Fears, MC70042060
• Featherstone Chiropractic Clinic, PLLC

• Pediatric Dentistry in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.