Provider Demographics
NPI:1053472613
Name:SHAH, DEVANG VINAYKANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:VINAYKANT
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 1:5455 MCGINNIS VILLAGE PLACE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2648
Mailing Address - Country:US
Mailing Address - Phone:770-751-1500
Mailing Address - Fax:770-751-1508
Practice Address - Street 1:5455 MCGINNIS VILLAGE PLACE
Practice Address - Street 2:SUITE 103
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2648
Practice Address - Country:US
Practice Address - Phone:770-751-1500
Practice Address - Fax:770-751-1508
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411757122300000X
GADN013630122300000X, 1223G0001X
PADS0368721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist