Active NPI
Iman Shahine, DDS
- Dentist
- Cicero, NY
National Provider Identifier
1720076979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 051526
- Practice address
- 7770 Frontage Rd
Cicero, NY 13039-8600 - Phone
- (315) 458-3088
- Fax
- (315) 458-5382
- NPI assigned
- Oct 12, 2005
- Last updated
- Jul 13, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 051526 | NY | Primary |
Addresses
Primary practice location
7770 Frontage Rd
Cicero, NY 13039-8600
Mailing address
628 Bradford Pkwy
Dewitt, NY 13214
Phone (315) 458-3088
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02608079 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051526 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syracuse Community Health Center, Inc. | Past | Accepting new patients | |
| Cicero Dental Associates | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Cicero, NY
- NPI 1053478743
-
- Federally Qualified Health Center (FQHC)
- Syracuse, NY
- NPI 1497796353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1720076979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 BRADFORD PKWY",
"city": "DEWITT",
"state": "NY",
"postal_code": "13214",
"telephone_number": "315-458-3088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7770 FRONTAGE RD",
"city": "CICERO",
"state": "NY",
"postal_code": "130398600",
"telephone_number": "315-458-3088",
"fax_number": "315-458-5382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHINE",
"first_name": "IMAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "051526",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02608079",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cicero, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.