Provider Demographics
NPI:1750455549
Name:SHAH, UDAY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:UDAY
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14708 PIPELINE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1296
Mailing Address - Country:US
Mailing Address - Phone:909-606-4337
Mailing Address - Fax:909-606-3223
Practice Address - Street 1:14708 PIPELINE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1296
Practice Address - Country:US
Practice Address - Phone:909-606-4337
Practice Address - Fax:909-606-3223
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice