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General NPI Number Information
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NPI Number | 1710303326
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Entity Type | Organization
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Legal Business Name | SHAH DENTAL ASSOCIATES INC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 10929 SOUTH ST STE 110B
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City | CERRITOS
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State | CA
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Zip | 90703-5340
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Country | US
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Telephone | 562-860-6626
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Fax | 562-860-6628
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Provider Business Mailing Address
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Address Line | 10929 SOUTH ST STE 110B
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City | CERRITOS
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State | CA
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Zip | 90703-5340
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Country | US
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Telephone | 562-860-6626
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Fax | 562-860-6628
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMIT SHAH
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Credential | DDS
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Telephone | 562-860-6626
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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 | 49805
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License Number State | CA
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