Provider Demographics
NPI:1326690173
Name:SHAH NIRAJ & MEGHA DENTAL PRACTICE, INC.
Entity Type:Organization
Organization Name:SHAH NIRAJ & MEGHA DENTAL PRACTICE, INC.
Other - Org Name:SMILE360 FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:909-980-4878
Mailing Address - Street 1:9778 19TH ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3538
Mailing Address - Country:US
Mailing Address - Phone:909-980-4878
Mailing Address - Fax:
Practice Address - Street 1:9778 19TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3538
Practice Address - Country:US
Practice Address - Phone:909-980-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental