Provider Demographics
NPI:1518039098
Name:SHAH & SHAH DENTAL PRACTICE
Entity type:Organization
Organization Name:SHAH & SHAH DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-751-6856
Mailing Address - Street 1:440 FAIR DR
Mailing Address - Street 2:STE R
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-751-6856
Mailing Address - Fax:714-781-6663
Practice Address - Street 1:440 FAIR DR
Practice Address - Street 2:STE R SHAH & SHAH DENTAL PRACTICE
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-751-6856
Practice Address - Fax:714-781-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty