Provider Demographics
NPI:1457090383
Name:SHAH, MAITRI DIVYANGKUMAR (DMD, MHA, BDS)
Entity Type:Individual
Prefix:DR
First Name:MAITRI
Middle Name:DIVYANGKUMAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD, MHA, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1926
Mailing Address - Country:US
Mailing Address - Phone:267-504-8422
Mailing Address - Fax:
Practice Address - Street 1:832 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2442
Practice Address - Country:US
Practice Address - Phone:610-277-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0436431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice