Provider Demographics
NPI:1255762662
Name:SHASTRI, PADMAPRIYA (DDS)
Entity type:Individual
Prefix:
First Name:PADMAPRIYA
Middle Name:
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3196
Mailing Address - Country:US
Mailing Address - Phone:347-867-2175
Mailing Address - Fax:
Practice Address - Street 1:3175 S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3196
Practice Address - Country:US
Practice Address - Phone:347-867-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631471223G0001X
TX295941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice