Provider Demographics
NPI:1902063118
Name:SHIBATA, WILLIAM H (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:SHIBATA
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 1:34400 DATE PALM DR
Mailing Address - Street 2:SUITE # E
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6837
Mailing Address - Country:US
Mailing Address - Phone:760-328-1400
Mailing Address - Fax:760-321-9491
Practice Address - Street 1:34400 DATE PALM DR
Practice Address - Street 2:SUITE # E
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6837
Practice Address - Country:US
Practice Address - Phone:760-328-1400
Practice Address - Fax:760-321-9491
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics