Provider Demographics
NPI:1821660663
Name:SHAH, FENAL BHARATKUMAR
Entity Type:Individual
Prefix:DR
First Name:FENAL
Middle Name:BHARATKUMAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18943 VICKIE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6219
Mailing Address - Country:US
Mailing Address - Phone:203-747-4000
Mailing Address - Fax:
Practice Address - Street 1:18943 VICKIE AVE APT 4
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6219
Practice Address - Country:US
Practice Address - Phone:203-747-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist