Healthcare Provider Details

I. General information

NPI: 1841587425
Provider Name (Legal Business Name): SHAMSHUDIN KHERANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HILLSHIRE DR
LAS VEGAS NV
89134-6365
US

IV. Provider business mailing address

9804 MOONRIDGE CT
LAS VEGAS NV
89134-6737
US

V. Phone/Fax

Practice location:
  • Phone: 650-204-0726
  • Fax: 702-202-2506
Mailing address:
  • Phone: 650-204-0726
  • Fax: 702-202-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5735
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number57908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: