MEDICARE: SHIREEN CHOUDHURY DDS A PROFESSIONAL DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	47058	CA

General Provider Information

NPI Number	:	1073788170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIREEN CHOUDHURY DDS A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2425 CALIFORNIA ST STE D
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-1462
Country	:	US
Telephone Number	:	650-967-1389
Fax Number	:	650-852-9756

Provider Business Practice Location Address
First Line	:	2425 CALIFORNIA ST STE D
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-1462
Country	:	US
Telephone Number	:	650-967-1389
Fax Number	:	650-852-9756

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHIREEN CHOUDHURY
Credential	:	DDS
Telephone Number	:	650-967-1389

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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