Provider Demographics
NPI:1245383280
Name:SHAH, GRISHMA RAJEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRISHMA
Middle Name:RAJEN
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E BALL RD
Mailing Address - Street 2:STE. 150
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5054
Mailing Address - Country:US
Mailing Address - Phone:714-533-9670
Mailing Address - Fax:714-533-8509
Practice Address - Street 1:2500 E BALL RD
Practice Address - Street 2:STE. 150
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5054
Practice Address - Country:US
Practice Address - Phone:714-533-9670
Practice Address - Fax:714-533-8509
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice