Provider Demographics
NPI:1134301385
Name:SHUKLA, PRIYANKA (BDS,MS)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:BDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2253
Mailing Address - Country:US
Mailing Address - Phone:617-296-0061
Mailing Address - Fax:
Practice Address - Street 1:1425 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2253
Practice Address - Country:US
Practice Address - Phone:617-296-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97311223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health