MEDICARE: PADMAPRIYA SHASTRI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	63147	CA
2	1223G0001X	General Practice Dentistry	29594	TX

General Provider Information

NPI Number	:	1255762662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PADMAPRIYA SHASTRI DDS

Provider Business Mailing Address
First Line	:	3175 S HOOVER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3196
Country	:	US
Telephone Number	:	347-867-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 S HOOVER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3196
Country	:	US
Telephone Number	:	347-867-2175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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Directions to “ PADMAPRIYA SHASTRI DDS” Practice Location

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