Provider Demographics
NPI:1437271368
Name:SHAH, SHISHIR NAVINCHANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:SHISHIR
Middle Name:NAVINCHANDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28305 MOUNTAIN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-6908
Mailing Address - Country:US
Mailing Address - Phone:760-751-9592
Mailing Address - Fax:760-744-1342
Practice Address - Street 1:1582 W SAN MARCOS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-744-1300
Practice Address - Fax:760-744-1342
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice