Provider Demographics
NPI:1790173086
Name:SHALINI SHAH DDS INC.
Entity Type:Organization
Organization Name:SHALINI SHAH DDS INC.
Other - Org Name:A KIDS DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-379-7755
Mailing Address - Street 1:6552 BOLSA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2656
Mailing Address - Country:US
Mailing Address - Phone:714-379-7755
Mailing Address - Fax:714-379-1155
Practice Address - Street 1:6552 BOLSA AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2656
Practice Address - Country:US
Practice Address - Phone:714-379-7755
Practice Address - Fax:714-379-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty