Provider Demographics
NPI:1225166127
Name:AMIT LALIT SHAH DDS INC
Entity Type:Organization
Organization Name:AMIT LALIT SHAH DDS INC
Other - Org Name:TUSTIN SMILES DENTAL OFFICE OF DR. SHAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:LALIT
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-694-3984
Mailing Address - Street 1:17601 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1946
Mailing Address - Country:US
Mailing Address - Phone:714-544-7511
Mailing Address - Fax:714-544-8918
Practice Address - Street 1:17601 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1946
Practice Address - Country:US
Practice Address - Phone:714-544-7511
Practice Address - Fax:714-544-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9331401OtherMEDICAL