Provider Demographics
NPI:1326137423
Name:SHAH, SHREYANS S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHREYANS
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1300
Mailing Address - Country:US
Mailing Address - Phone:973-696-4252
Mailing Address - Fax:
Practice Address - Street 1:157 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07440-1300
Practice Address - Country:US
Practice Address - Phone:973-696-4252
Practice Address - Fax:973-872-9018
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI216091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice