Provider Demographics
NPI:1801038252
Name:ALI SHAHZAD- GHAJAR DDS INC
Entity Type:Organization
Organization Name:ALI SHAHZAD- GHAJAR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD GHAJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-933-3531
Mailing Address - Street 1:1361 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3035
Mailing Address - Country:US
Mailing Address - Phone:909-933-3531
Mailing Address - Fax:909-933-3533
Practice Address - Street 1:1361 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3035
Practice Address - Country:US
Practice Address - Phone:909-933-3531
Practice Address - Fax:909-933-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty