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General NPI Number Information
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NPI Number | 1407101397
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Entity Type | Organization
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Legal Business Name | MALA SHETH DDS INC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 833 W TORRANCE BLVD SUITE 104
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City | TORRANCE
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State | CA
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Zip | 90502-1735
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Country | US
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Telephone | 310-538-3639
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Fax | 310-538-1410
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Provider Business Mailing Address
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Address Line | 833 W TORRANCE BLVD SUITE 104
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City | TORRANCE
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State | CA
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Zip | 90502-1735
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Country | US
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Telephone | 310-538-3639
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Fax | 310-538-1410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MALA D SHETH
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Credential | DDS
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Telephone | 310-538-3639
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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 | B33371
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License Number State | CA
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