Provider Demographics
NPI:1689918856
Name:THATTE, SHALINI S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:S
Last Name:THATTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 MIRA MESA BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4848
Mailing Address - Country:US
Mailing Address - Phone:858-271-0600
Mailing Address - Fax:
Practice Address - Street 1:9420 MIRA MESA BLVD STE G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4848
Practice Address - Country:US
Practice Address - Phone:858-271-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI025208001223G0001X
CT0108771223G0001X
CA630721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice