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General NPI Number Information
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NPI Number | 1336559384
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Entity Type | Organization
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Legal Business Name | B SHELAT INC.
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 4925 SISK RD STE A
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City | SALIDA
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State | CA
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Zip | 95368-9400
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Country | US
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Telephone | 510-456-6136
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Fax |
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Provider Business Mailing Address
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Address Line | 4232 ACCLAIM WAY
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City | MODESTO
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State | CA
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Zip | 95356-1884
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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 | PRESIDENT
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Name | BHAVINI SHELAT
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Credential |
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Telephone | 510-456-6136
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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 | 56738
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License Number State | CA
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