Healthcare Provider Details

I. General information

NPI: 1851219786
Provider Name (Legal Business Name): SHAH SHAH AND GODINEZ DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 S AZUSA AVE STE B
WEST COVINA CA
91792-1540
US

IV. Provider business mailing address

137 W CHAPMAN AVE STE A
FULLERTON CA
92832-1473
US

V. Phone/Fax

Practice location:
  • Phone: 714-823-3743
  • Fax:
Mailing address:
  • Phone: 714-823-3743
  • Fax: 714-694-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMIT SHAH
Title or Position: PART OWNER
Credential:
Phone: 714-823-3743