Provider Demographics
NPI:1164571295
Name:SHAH, JAYSHREE NARENDRA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JAYSHREE
Middle Name:NARENDRA
Last Name:SHAH
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 1:301 W BASTANCHURY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3422
Mailing Address - Country:US
Mailing Address - Phone:714-871-4892
Mailing Address - Fax:714-871-4896
Practice Address - Street 1:301 W BASTANCHURY RD STE 5
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3422
Practice Address - Country:US
Practice Address - Phone:714-871-4892
Practice Address - Fax:714-871-4896
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist