Provider Demographics
NPI:1619171733
Name:BANERJEE, SHIKHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIKHA
Middle Name:
Last Name:BANERJEE
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 1:2097 COMPTON AVE BLDG 1102A
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7282
Mailing Address - Country:US
Mailing Address - Phone:951-273-0555
Mailing Address - Fax:951-273-1555
Practice Address - Street 1:2097 COMPTON AVE BLDG 1102A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-273-0555
Practice Address - Fax:951-273-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist