Provider Demographics
NPI:1093973356
Name:SHAH, KRUPALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRUPALI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRUPALI
Other - Middle Name:MALAY
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5 WILLETS DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3913
Mailing Address - Country:US
Mailing Address - Phone:773-407-1004
Mailing Address - Fax:
Practice Address - Street 1:120 BETHPAGE RD STE 310
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:773-407-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027638122300000X
NY056445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist