Provider Demographics
NPI:1154662922
Name:KAZI, SHITAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHITAL
Middle Name:
Last Name:KAZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEWELLING BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1628
Mailing Address - Country:US
Mailing Address - Phone:510-276-6040
Mailing Address - Fax:501-315-4886
Practice Address - Street 1:10 LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1628
Practice Address - Country:US
Practice Address - Phone:510-276-6040
Practice Address - Fax:501-315-4886
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist