Healthcare Provider Details

I. General information

NPI: 1649885211
Provider Name (Legal Business Name): NIRALEE ROHIT SHAH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49127 ROAD 426 STE 1&2
OAKHURST CA
93644-8702
US

IV. Provider business mailing address

49127 ROAD 426 STE 1&2
OAKHURST CA
93644-8702
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-664-4000
  • Fax: 559-675-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: