Provider Demographics
NPI:1003599556
Name:ISHANI SHAH DDS, INC
Entity Type:Organization
Organization Name:ISHANI SHAH DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:194-983-1839
Mailing Address - Street 1:27001 MOULTON PKWY STE A206
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3628
Mailing Address - Country:US
Mailing Address - Phone:949-831-8391
Mailing Address - Fax:949-716-7429
Practice Address - Street 1:27001 MOULTON PKWY STE A206
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3628
Practice Address - Country:US
Practice Address - Phone:949-831-8391
Practice Address - Fax:949-716-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental