MEDICARE: DR AQEELA SYEDA SHAH DDS INC

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	261QD0000X	Dental Clinic/Center	58179	CA

General Provider Information

NPI Number	:	1285075960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR AQEELA SYEDA SHAH DDS INC

Provider Business Mailing Address
First Line	:	3839 W 1ST ST
Second Line	:	B-1
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-5062
Fax Number	:	714-554-5063

Provider Business Practice Location Address
First Line	:	3839 W 1ST ST
Second Line	:	B-1
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-5062
Fax Number	:	714-554-5063

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AQEELA SYEDA SHAH
Credential	:	DDS
Telephone Number	:	714-554-5062

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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