Provider Demographics
NPI:1033260153
Name:SHAIN, NAT R (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAT
Middle Name:R
Last Name:SHAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3442
Mailing Address - Country:US
Mailing Address - Phone:951-788-4500
Mailing Address - Fax:
Practice Address - Street 1:4151 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3442
Practice Address - Country:US
Practice Address - Phone:951-788-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37286OtherMOST INS. PROVIDER #
CAG92268-01Medicaid