Healthcare Provider Details

I. General information

NPI: 1538360797
Provider Name (Legal Business Name): SHIRA SHASHO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 MIRA MESA BLVD STE 210
SAN DIEGO CA
92126-4811
US

IV. Provider business mailing address

11120 E OCEAN AIR DR STE 101-108
SAN DIEGO CA
92130-4683
US

V. Phone/Fax

Practice location:
  • Phone: 858-201-9483
  • Fax:
Mailing address:
  • Phone: 858-201-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number58467
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: