Fariba Shafii, DDS
Individual provider Active NPI General Practice Dentistry · Mulberry, FL
NPI 1558433490 · NPPES record last updated Jan 14, 2014
Key facts
- NPI
- 1558433490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN 13663 (FL)
- Practice address
- 105 N Church Ave
Mulberry, FL 33860-2413 - Phone
- (863) 869-8888
- Fax
- (863) 869-8880
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 13663 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mulberry Dental Care Inc. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN 13663 | FL | Yes |
Addresses
Primary practice location
105 N Church Ave
Mulberry, FL 33860-2413
Mailing address
105 N Church Ave
Mulberry, FL 33860-2413
Phone (863) 869-8888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071504200 | Medicaid | FL | |
| 59-3419655 | Other | FL | TAX ID # |
| DN13663 | Other | FL | LICENSE # |
Other providers in Mulberry, FL
- Bridget Ross
- Ria Sajnani
- Salazar Family Health Care, Inc
- Maria V Santaella
- Yudith Santana Gallardo
- Abhaykumar Sobhagchand Shah
- Angel R Sloan
- Angela Smith
- Suzanne Kathleen Smith
- David Michael Swager
All providers in Mulberry, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.