Provider Demographics
NPI:1396397345
Name:MANOJ SHAH, SHIKHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIKHA
Middle Name:
Last Name:MANOJ SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 VIA MARINA APT 103
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5328
Mailing Address - Country:US
Mailing Address - Phone:517-817-6338
Mailing Address - Fax:
Practice Address - Street 1:4163 VIA MARINA APT 103
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5328
Practice Address - Country:US
Practice Address - Phone:517-817-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist