Provider Demographics
NPI:1053541482
Name:KABANI, SHAILA A (DDS)
Entity type:Individual
Prefix:
First Name:SHAILA
Middle Name:A
Last Name:KABANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:#220
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1422
Mailing Address - Country:US
Mailing Address - Phone:770-476-9004
Mailing Address - Fax:
Practice Address - Street 1:20214 SUGARLOAF RESERVE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5216
Practice Address - Country:US
Practice Address - Phone:678-343-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist