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General NPI Number Information
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NPI Number | 1003588302
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Entity Type | Organization
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Legal Business Name | SHRIRAJ SHAH DDS, INC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 16184 FOOTHILL BLVD STE K
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City | FONTANA
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State | CA
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Zip | 92335-7400
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Country | US
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Telephone | 909-770-8916
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Fax |
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Provider Business Mailing Address
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Address Line | 16675 SLATE DR UNIT 122
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City | CHINO HILLS
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State | CA
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Zip | 91709-7402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. SHRIRAJ ASHOK SHAH
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Credential | DDS
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Telephone | 408-531-7182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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