Provider Demographics
NPI:1437847712
Name:SHAH, MISHA RAHUL (DMD)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:RAHUL
Last Name:SHAH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 HOMECOMING DR UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8819
Mailing Address - Country:US
Mailing Address - Phone:908-294-5965
Mailing Address - Fax:
Practice Address - Street 1:510 E 3RD ST APT 301
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1942
Practice Address - Country:US
Practice Address - Phone:908-294-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA109105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program