Healthcare Provider Details

I. General information

NPI: 1184371866
Provider Name (Legal Business Name): SAIF SHAH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N FRESNO ST
FRESNO CA
93701-2312
US

IV. Provider business mailing address

215 N FRESNO ST STE 490
FRESNO CA
93701-2363
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4101
  • Fax:
Mailing address:
  • Phone: 559-459-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR61286078
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number111740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: