Provider Demographics
NPI:1639675978
Name:CHAUDHRY, AMINA JAVAID SHELLY (DDS)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:JAVAID SHELLY
Last Name:CHAUDHRY
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 1:941 W MISSION BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6890
Mailing Address - Country:US
Mailing Address - Phone:909-984-7883
Mailing Address - Fax:
Practice Address - Street 1:941 W MISSION BLVD STE H
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6890
Practice Address - Country:US
Practice Address - Phone:909-984-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist