Mondana Nicole Shamsazar, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D011727 Issued in AZ

Practice address

500 N Estrella Pkwy Ste B1
Goodyear, AZ 85338-4136

Phone

(623) 688-5408

NPI assigned

Aug 22, 2019

Last updated

Jul 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Goodyear Modern Dentistry, LLP

  dba Goodyear Modern Dentistry

  • Dentist
  • Goodyear, AZ
  • NPI 1912497504
  NPD (past)
• Sleep Impressions, LLC

  dba Sleep Impressions

  • Specialist
  • Saint Louis, MO
  • NPI 1134547912

  Dentist

  NPD (past)

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1831746932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15260 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952530",
            "telephone_number": "623-207-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY STE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384136",
            "telephone_number": "623-688-5408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15260 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952530",
            "country_code": "US",
            "telephone_number": "623-207-7838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20800 W Market St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Buckeye",
            "state": "AZ",
            "postal_code": "853968040",
            "country_code": "US",
            "telephone_number": "623-900-9996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMSAZAR",
        "first_name": "MONDANA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-22",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16999",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011727",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon L Seyedan, LCSW, LISAC
• Hind Shabany, M.D.
• Firas N Shadad, MD
• Shruti Shah, MD
• Anitha Shaju
• Toni Deneice Sharon, FNP-C
• Lawrence Eugene Shauf, PT
• Mary Shaw, SLP
• Abby Sheahan, LPC
• Cynthia Louise Shembab, LAMFT

• Dentist in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.