Provider Demographics
NPI:1821529009
Name:AMIT SHAH D.D.S
Entity Type:Organization
Organization Name:AMIT SHAH D.D.S
Other - Org Name:CREATIVE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-738-6001
Mailing Address - Street 1:137 W. CHAPMAN AVE #A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832
Mailing Address - Country:US
Mailing Address - Phone:714-738-6001
Mailing Address - Fax:714-738-0179
Practice Address - Street 1:137 W CHAPMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1473
Practice Address - Country:US
Practice Address - Phone:714-738-6001
Practice Address - Fax:714-738-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49805305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437207701OtherINDIVIDUAL