Provider Demographics
NPI:1780992099
Name:SHANKAR, SHIV M (DDS)
Entity type:Individual
Prefix:
First Name:SHIV
Middle Name:M
Last Name:SHANKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 VASSAR AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303
Mailing Address - Country:US
Mailing Address - Phone:818-347-2088
Mailing Address - Fax:818-347-2188
Practice Address - Street 1:7220 VASSAR AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303
Practice Address - Country:US
Practice Address - Phone:818-347-2088
Practice Address - Fax:818-347-2188
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist