Provider Demographics
NPI:1003129255
Name:SHAH, AMIT (DDS)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 E. WEST MAPLE RD.
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3807
Mailing Address - Country:US
Mailing Address - Phone:248-624-5551
Mailing Address - Fax:248-624-2475
Practice Address - Street 1:3392 E WEST MAPLE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3807
Practice Address - Country:US
Practice Address - Phone:248-624-5551
Practice Address - Fax:248-624-2475
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI201641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice