Provider Demographics
NPI:1124431085
Name:SHAH, SITAL ANAND (DDS)
Entity type:Individual
Prefix:
First Name:SITAL
Middle Name:ANAND
Last Name:SHAH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:SITAL
Other - Middle Name:VIRENDRA
Other - Last Name:MANDALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 N ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7520
Mailing Address - Country:US
Mailing Address - Phone:562-569-5808
Mailing Address - Fax:
Practice Address - Street 1:724 N ROSE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7520
Practice Address - Country:US
Practice Address - Phone:562-569-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist