Healthcare Provider Details

I. General information

NPI: 1659926939
Provider Name (Legal Business Name): MANALI SHAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 WARNER AVE STE 202
HUNTINGTON BEACH CA
92649-4473
US

IV. Provider business mailing address

4911 WARNER AVE STE 202
HUNTINGTON BEACH CA
92649-4473
US

V. Phone/Fax

Practice location:
  • Phone: 714-846-4414
  • Fax: 714-846-7655
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: