Provider Demographics
NPI:1366652752
Name:SHAH, TANVI MAHIPAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANVI
Middle Name:MAHIPAL
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BRANNAN ST UNIT 17E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4061
Mailing Address - Country:US
Mailing Address - Phone:415-515-9581
Mailing Address - Fax:
Practice Address - Street 1:8201 EDGEWATER DR STE 105
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2021
Practice Address - Country:US
Practice Address - Phone:510-568-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist