Provider Demographics
NPI:1699905430
Name:SHAH, AMIT (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18377 BEACH BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1349
Mailing Address - Country:US
Mailing Address - Phone:714-698-9950
Mailing Address - Fax:
Practice Address - Street 1:18377 BEACH BLVD STE 216
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1349
Practice Address - Country:US
Practice Address - Phone:714-698-9950
Practice Address - Fax:714-698-9980
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry