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General NPI Number Information
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NPI Number | 1184792467
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Entity Type | Individual
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Provider Name | DR. SHAILAJA MENON
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1821 CONCORD AVE
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City | CONCORD
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State | CA
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Zip | 94520-2348
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Country | US
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Telephone | 925-825-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 ALPINA CT
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City | PLEASANTON
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State | CA
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Zip | 94588-9614
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Country | US
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Telephone | 925-398-8286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50955
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License Number State | CA
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