Shadzi Jebraeili, DMD, MS, Ortho Cert.
Dentist, Orthodontics and Dentofacial Orthopedics in San Antonio, TX. Individual provider (NPI-1).
NPI number1669964870
StatusActive
Last updated in NPPESOct 21, 2020
Details
- NPI
- 1669964870
- Entity type
- Individual (NPI-1)
- Name
- Shadzi Jebraeili
- Credential
- DMD, MS, Ortho Cert.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 4, 2018
- Certification date
- Oct 21, 2020
- Last updated
- Oct 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | 31669 | TX | Yes |
| 1223G0001X | Dentist, General Practice | 31669 | TX |
Practice location
8210 Floyd Curl DrSan Antonio, TX 78229-3923
Phone 210-450-3500
Mailing address
18 Beaverbrook CrescentMaple, ONTARIO L6A3T2
Canada
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