Provider Demographics
NPI:1003161613
Name:SHAH, DHAVAL (DDS)
Entity Type:Individual
Prefix:
First Name:DHAVAL
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 1:1074 GRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2292
Mailing Address - Country:US
Mailing Address - Phone:732-599-8784
Mailing Address - Fax:
Practice Address - Street 1:292 W RIDGE PIKE
Practice Address - Street 2:BULD- B, SECOND FLOOR
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-3716
Practice Address - Country:US
Practice Address - Phone:484-973-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029123122300000X
PADS039259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist