Provider Demographics
NPI:1033735816
Name:SHAH, ROHAN JAYESHKUMAR (DMD)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:JAYESHKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WOLF RD UNIT 322
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1953
Mailing Address - Country:US
Mailing Address - Phone:908-456-7464
Mailing Address - Fax:
Practice Address - Street 1:31 OLD ETNA RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1933
Practice Address - Country:US
Practice Address - Phone:908-456-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist