Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 34890 | CA |
NPI | 1003933136 |
---|---|
Provider Name | Shalabh Puri |
First Address | Oxnard, CA 93030-5314 |
Second Address | Oxnard, CA 93030-5314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |