Provider Demographics
NPI:1710113964
Name:SHAH, KRUTIKA ANISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRUTIKA
Middle Name:ANISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRUTIKA
Other - Middle Name:NAUTAMLAL
Other - Last Name:SANGHVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1307 W 6TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-1642
Mailing Address - Country:US
Mailing Address - Phone:954-600-2360
Mailing Address - Fax:
Practice Address - Street 1:1307 W 6TH ST STE 111
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1642
Practice Address - Country:US
Practice Address - Phone:954-600-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice