Provider Demographics
NPI:1184294068
Name:SHAH, CLARISSA SUZETTE BURQUEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:SUZETTE BURQUEZ
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:BURQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3980 S MERRYVALE WAY
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-3833
Mailing Address - Country:US
Mailing Address - Phone:562-656-9515
Mailing Address - Fax:
Practice Address - Street 1:14545 LEFFINGWELL RD UNIT A
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-2898
Practice Address - Country:US
Practice Address - Phone:562-941-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice