Provider Demographics
NPI:1164690004
Name:SHAH, NEEPA BANKIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEEPA
Middle Name:BANKIM
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 1:470 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3262
Mailing Address - Country:US
Mailing Address - Phone:973-546-6977
Mailing Address - Fax:973-253-8637
Practice Address - Street 1:470 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3262
Practice Address - Country:US
Practice Address - Phone:973-546-6977
Practice Address - Fax:973-253-8637
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022889011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice