Provider Demographics
NPI:1992910640
Name:SHITABATA, CHRIS (DDS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:SHITABATA
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 1:8311 HAVEN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3867
Mailing Address - Country:US
Mailing Address - Phone:909-948-8980
Mailing Address - Fax:909-941-4098
Practice Address - Street 1:8311 HAVEN AVE STE 220
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3867
Practice Address - Country:US
Practice Address - Phone:909-948-8980
Practice Address - Fax:909-941-4098
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist