Provider Demographics
NPI:1407101397
Name:MALA SHETH DDS INC
Entity Type:Organization
Organization Name:MALA SHETH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-538-3639
Mailing Address - Street 1:833 W TORRANCE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1735
Mailing Address - Country:US
Mailing Address - Phone:310-538-3639
Mailing Address - Fax:310-538-1410
Practice Address - Street 1:833 W TORRANCE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1735
Practice Address - Country:US
Practice Address - Phone:310-538-3639
Practice Address - Fax:310-538-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB33371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB33371Medicaid