Provider Demographics
NPI:1215231949
Name:MASHRUWALA, SHAILEE SAMIR (DDS)
Entity Type:Individual
Prefix:
First Name:SHAILEE
Middle Name:SAMIR
Last Name:MASHRUWALA
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 1:10933 ROCHESTER AVE
Mailing Address - Street 2:APT#119
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7702
Mailing Address - Country:US
Mailing Address - Phone:847-370-2573
Mailing Address - Fax:
Practice Address - Street 1:10933 ROCHESTER AVE
Practice Address - Street 2:APT#119
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-7702
Practice Address - Country:US
Practice Address - Phone:847-370-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry