Provider Demographics
NPI:1285075960
Name:DR AQEELA SYEDA SHAH DDS INC
Entity type:Organization
Organization Name:DR AQEELA SYEDA SHAH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AQEELA
Authorized Official - Middle Name:SYEDA
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-554-5062
Mailing Address - Street 1:3839 W 1ST ST
Mailing Address - Street 2:B-1
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4075
Mailing Address - Country:US
Mailing Address - Phone:714-554-5062
Mailing Address - Fax:714-554-5063
Practice Address - Street 1:3839 W 1ST ST
Practice Address - Street 2:B-1
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4075
Practice Address - Country:US
Practice Address - Phone:714-554-5062
Practice Address - Fax:714-554-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58179261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental