Provider Demographics
NPI:1346508785
Name:SHAH, KAJEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAJEL
Middle Name:
Last Name:SHAH
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 1:534 10TH ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3199
Mailing Address - Country:US
Mailing Address - Phone:727-686-5501
Mailing Address - Fax:
Practice Address - Street 1:534 10TH ST
Practice Address - Street 2:SUITE A1
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3199
Practice Address - Country:US
Practice Address - Phone:727-686-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9709122300000X
TX30355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist