Provider Demographics
NPI:1225573678
Name:VOHRA, SHANA (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:VOHRA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 FLEUR DE LIS DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9304
Mailing Address - Country:US
Mailing Address - Phone:209-324-9372
Mailing Address - Fax:
Practice Address - Street 1:9565 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-7500
Practice Address - Country:US
Practice Address - Phone:520-885-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ95811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics