Provider Demographics
NPI:1053423632
Name:SHEMSHAKI, KAMARAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KAMARAN
Middle Name:
Last Name:SHEMSHAKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18516 NE 26 STREET
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-881-9414
Mailing Address - Fax:425-881-9414
Practice Address - Street 1:2955 80TH AVE SE
Practice Address - Street 2:SUITE #203
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-236-2681
Practice Address - Fax:206-236-7221
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist