Provider Demographics
NPI:1750560744
Name:DR.JATIN P. SHAH, D.D.S. , INC.
Entity type:Organization
Organization Name:DR.JATIN P. SHAH, D.D.S. , INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:PRABHUDAS
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-697-3788
Mailing Address - Street 1:1281 E LA HABRA BLVD
Mailing Address - Street 2:#4
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5600
Mailing Address - Country:US
Mailing Address - Phone:562-697-3788
Mailing Address - Fax:
Practice Address - Street 1:1281 E LA HABRA BLVD
Practice Address - Street 2:#4
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5600
Practice Address - Country:US
Practice Address - Phone:562-697-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty