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General NPI Number Information
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NPI Number | 1245949874
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Entity Type | Individual
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Provider Name | DR. ANSHUMI SHAH
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Gender | Female
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 121 BARBOZA ST
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City | MENDOTA
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State | CA
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Zip | 93640-1901
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Country | US
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Telephone | 424-350-1644
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Fax |
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Provider Business Mailing Address
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Address Line | 6104 PRESTON CIR
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City | ROCKLIN
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State | CA
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Zip | 95765-4773
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Country | US
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Telephone | 424-350-1644
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 107376
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License Number State | CA
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