Provider Demographics
NPI:1346437738
Name:SHAH, ANJU
Entity Type:Individual
Prefix:DR
First Name:ANJU
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 CHERRY AVE
Mailing Address - Street 2:STE F1340
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4222
Mailing Address - Country:US
Mailing Address - Phone:909-355-9350
Mailing Address - Fax:909-355-9342
Practice Address - Street 1:7360 CHERRY AVE
Practice Address - Street 2:STE F1340
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4222
Practice Address - Country:US
Practice Address - Phone:909-355-9350
Practice Address - Fax:909-355-9342
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice