Provider Demographics
NPI:1659586642
Name:SHAH, MARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name: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 1:3697 TURNER CT
Mailing Address - Street 2:S
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3624
Mailing Address - Country:US
Mailing Address - Phone:510-459-0922
Mailing Address - Fax:510-797-4590
Practice Address - Street 1:3697 TURNER COURT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536
Practice Address - Country:US
Practice Address - Phone:510-459-0922
Practice Address - Fax:510-797-4590
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist