Provider Demographics
NPI:1245575802
Name:SHAH, NIRMAL MAHESH (DDS)
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:MAHESH
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 1:549 H ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4302
Mailing Address - Country:US
Mailing Address - Phone:619-426-6891
Mailing Address - Fax:
Practice Address - Street 1:549 H ST STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4302
Practice Address - Country:US
Practice Address - Phone:619-426-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102335122300000X
PADS039424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist