Provider Demographics
NPI:1235380817
Name:SHAH, SAMIR ASHOK (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:ASHOK
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-646-8443
Mailing Address - Fax:609-646-2758
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:STE 101
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-646-8443
Practice Address - Fax:609-646-2758
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023846001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics