Provider Demographics
NPI:1679212625
Name:SHEHAYBER, FAYROZA SAMIR (DMD)
Entity type:Individual
Prefix:DR
First Name:FAYROZA
Middle Name:SAMIR
Last Name:SHEHAYBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7911
Mailing Address - Country:US
Mailing Address - Phone:469-712-2960
Mailing Address - Fax:
Practice Address - Street 1:8131 W 91ST ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1465
Practice Address - Country:US
Practice Address - Phone:708-228-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNA1223G0001X
TX40811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice