Provider Demographics
NPI:1689809410
Name:SHAH, AQEELA S (DDS)
Entity Type:Individual
Prefix:
First Name:AQEELA
Middle Name:S
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 1:3839 W 1ST ST
Mailing Address - Street 2:B-1
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4075
Mailing Address - Country:US
Mailing Address - Phone:714-554-5062
Mailing Address - Fax:714-554-5063
Practice Address - Street 1:3839 W 1ST ST
Practice Address - Street 2:B-1
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4075
Practice Address - Country:US
Practice Address - Phone:714-554-5062
Practice Address - Fax:714-554-5063
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist