Provider Demographics
NPI:1912056722
Name:SHAH, RAJUL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJUL
Middle Name:M
Last Name:SHAH
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 1:17586 DRY RUN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8820
Mailing Address - Country:US
Mailing Address - Phone:951-300-8171
Mailing Address - Fax:951-654-9423
Practice Address - Street 1:701 W ESPLANADE AVE
Practice Address - Street 2:STE K & L
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4540
Practice Address - Country:US
Practice Address - Phone:951-654-3424
Practice Address - Fax:951-654-9423
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193230807901Medicaid
CA193230807902Medicaid