Provider Demographics
NPI:1003980020
Name:SHAH, BHAVIK P (DDS)
Entity Type:Individual
Prefix:
First Name:BHAVIK
Middle Name:P
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 1:1240 HIGHWAY 54 W STE 315
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4572
Mailing Address - Country:US
Mailing Address - Phone:770-478-6878
Mailing Address - Fax:770-478-4642
Practice Address - Street 1:1240 HIGHWAY 54 W STE 315
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4572
Practice Address - Country:US
Practice Address - Phone:770-478-6878
Practice Address - Fax:770-478-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics