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General NPI Number Information
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NPI Number | 1205056264
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Entity Type | Individual
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Provider Name | RAJESH SHAH D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 N MCKINLEY ST STE. #105
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City | CORONA
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State | CA
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Zip | 92879-6562
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Country | US
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Telephone | 951-280-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 205 SAINT TROPEZ CT
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City | PLACENTIA
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State | CA
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Zip | 92870-5133
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Country | US
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Telephone | 714-572-3275
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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 | 46135
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License Number State | CA
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