Healthcare Provider Details

I. General information

NPI: 1104781012
Provider Name (Legal Business Name): SHRIRAJ SHAH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 LEFFINGWELL RD STE A
WHITTIER CA
90604-2898
US

IV. Provider business mailing address

3980 S MERRYVALE WAY
ONTARIO CA
91761-3833
US

V. Phone/Fax

Practice location:
  • Phone: 562-941-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHRIRAJ SHAH
Title or Position: CEO
Credential: DMD
Phone: 408-531-7182