Provider Demographics
NPI:1306343264
Name:CHOUDHARY, SHOBHITA (DMD)
Entity type:Individual
Prefix:
First Name:SHOBHITA
Middle Name:
Last Name:CHOUDHARY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12497 TAMARISK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1943
Mailing Address - Country:US
Mailing Address - Phone:909-251-5323
Mailing Address - Fax:
Practice Address - Street 1:2621 ZOE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4131
Practice Address - Country:US
Practice Address - Phone:323-582-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist