Provider Demographics
NPI:1346437738
Name:SHAH, ANJU
Entity type:Individual
Prefix:DR
First Name:ANJU
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 RUSTY PUMP RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3376
Mailing Address - Country:US
Mailing Address - Phone:909-641-1991
Mailing Address - Fax:
Practice Address - Street 1:16455 MAIN ST STE 17
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3505
Practice Address - Country:US
Practice Address - Phone:760-444-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics