Provider Demographics
NPI:1215215249
Name:SHAH, NISHMA SHIRISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NISHMA
Middle Name:SHIRISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 E COALTON RD APT 49-102
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4493
Mailing Address - Country:US
Mailing Address - Phone:847-322-8517
Mailing Address - Fax:
Practice Address - Street 1:14807 W 64TH AVE UNIT C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-0104
Practice Address - Country:US
Practice Address - Phone:303-456-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028857122300000X
CO104521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist