Provider Demographics
NPI:1396751939
Name:SHAH, PRATIK M (DDS)
Entity type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9415 MISSION BLVD
Mailing Address - Street 2:STE# L
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2600
Mailing Address - Country:US
Mailing Address - Phone:951-685-8500
Mailing Address - Fax:951-685-8488
Practice Address - Street 1:9415 MISSION BLVD
Practice Address - Street 2:STE# L
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-2600
Practice Address - Country:US
Practice Address - Phone:951-685-8500
Practice Address - Fax:951-685-8488
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA469591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice