Provider Demographics
NPI:1245422757
Name:SHAH, SHAYER R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAYER
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1345
Mailing Address - Country:US
Mailing Address - Phone:740-522-1133
Mailing Address - Fax:740-522-1178
Practice Address - Street 1:1619 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1345
Practice Address - Country:US
Practice Address - Phone:740-522-1133
Practice Address - Fax:740-522-1178
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice