Provider Demographics
NPI:1144745076
Name:SHALIKAR, MASTANE M (RDHAP)
Entity type:Individual
Prefix:
First Name:MASTANE
Middle Name:M
Last Name:SHALIKAR
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:MASTANEH
Other - Middle Name:SHALIKAR
Other - Last Name:HEIKALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10683 HOLMAN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5957
Mailing Address - Country:US
Mailing Address - Phone:310-696-1926
Mailing Address - Fax:
Practice Address - Street 1:10683 HOLMAN AVE
Practice Address - Street 2:#5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-696-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist