Provider Demographics
NPI:1043411572
Name:SHAH, NAMITA PRASHANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAMITA
Middle Name:PRASHANT
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3449
Mailing Address - Country:US
Mailing Address - Phone:973-537-8085
Mailing Address - Fax:
Practice Address - Street 1:447 ROUTE 10 E
Practice Address - Street 2:SUITE #3
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2132
Practice Address - Country:US
Practice Address - Phone:973-537-7500
Practice Address - Fax:973-537-7400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01915000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist