Provider Demographics
NPI:1679700553
Name:JALPAN SHAH DDS MDS INC.
Entity type:Organization
Organization Name:JALPAN SHAH DDS MDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JALPAN
Authorized Official - Middle Name:MANHARLAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MDS
Authorized Official - Phone:909-799-5656
Mailing Address - Street 1:11872 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6748
Mailing Address - Country:US
Mailing Address - Phone:909-799-5656
Mailing Address - Fax:909-663-5040
Practice Address - Street 1:1215 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4963
Practice Address - Country:US
Practice Address - Phone:909-794-5860
Practice Address - Fax:909-794-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty