Provider Demographics
NPI:1346408564
Name:JOBANPUTRA, SHILPA (DMD)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:JOBANPUTRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 HERITAGE CENTER DRIVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925
Mailing Address - Country:US
Mailing Address - Phone:215-794-2500
Mailing Address - Fax:
Practice Address - Street 1:2325 HERITAGE CENTER DR.
Practice Address - Street 2:SUITE 119
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925
Practice Address - Country:US
Practice Address - Phone:215-794-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028953L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice