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General NPI Number Information
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NPI Number | 1225166127
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Entity Type | Organization
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Legal Business Name | AMIT LALIT SHAH DDS INC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 17601 17TH ST STE 100
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City | TUSTIN
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State | CA
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Zip | 92780-1946
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Country | US
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Telephone | 714-544-7511
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Fax | 714-544-8918
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Provider Business Mailing Address
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Address Line | 17601 17TH ST STE 100
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City | TUSTIN
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State | CA
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Zip | 92780-1946
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Country | US
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Telephone | 714-544-7511
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Fax | 714-544-8918
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Authorized Official
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Title or Position | OWNER
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Name | AMIT LALIT SHAH
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Credential |
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Telephone | 562-694-3984
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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 | 49805
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License Number State | CA
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