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General NPI Number Information
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NPI Number | 1457412611
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Entity Type | Individual
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Provider Name | SAMIR B SHAH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 469 W BASE LINE RD
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City | RIALTO
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State | CA
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Zip | 92376-3379
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Country | US
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Telephone | 909-746-0444
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Fax | 909-746-0447
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Provider Business Mailing Address
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Address Line | 469 W BASE LINE RD
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City | RIALTO
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State | CA
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Zip | 92376-3379
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Country | US
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Telephone | 909-746-0444
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Fax | 909-746-0447
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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 | 53272
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License Number State | CA
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