Provider Demographics
NPI:1275985889
Name:SHAH, YASHONI
Entity Type:Individual
Prefix:
First Name:YASHONI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 N OAK TRFY STE 8
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3353
Mailing Address - Country:US
Mailing Address - Phone:816-468-6767
Mailing Address - Fax:
Practice Address - Street 1:6651 N OAK TRFY STE 8
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-3353
Practice Address - Country:US
Practice Address - Phone:816-468-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61435122300000X
MO20200066283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist