| Samir Shah Dds Inc | |
|
469 W Base Line Rd Rialto CA 92376-3379 | |
| (909) 746-0444 | |
| Not Available |
| Full Name | Samir Shah Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 469 W Base Line Rd, Rialto, California |
| Authorized Official Name and Position | Samir Shah (OWNER) |
| Authorized Official Contact | 9097460444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samir Shah Dds Inc 469 W Base Line Rd Rialto CA 92376-3379 Ph: () - | Samir Shah Dds Inc 469 W Base Line Rd Rialto CA 92376-3379 Ph: (909) 746-0444 |
| NPI Number | 1871091645 |
|---|---|
| Provider Enumeration Date | 01/26/2018 |
| Last Update Date | 01/26/2018 |
| Medicare PECOS PAC ID | 4789947110 |
|---|---|
| Medicare Enrollment ID | O20180417000522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871091645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | 53272 (California) | Primary |
| Provider Name | Samir B Shah |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1457412611 PECOS PAC ID: 5698038024 Enrollment ID: I20180417000665 |
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