Provider Demographics
NPI:1457684623
Name:SHAH, SRUJAL HARSHAD (DDS, DABDSM, DASBA)
Entity Type:Individual
Prefix:DR
First Name:SRUJAL
Middle Name:HARSHAD
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS, DABDSM, DASBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 HELLYER AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1066
Mailing Address - Country:US
Mailing Address - Phone:408-490-0182
Mailing Address - Fax:408-624-4545
Practice Address - Street 1:6120 HELLYER AVE STE 125
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1066
Practice Address - Country:US
Practice Address - Phone:408-490-0182
Practice Address - Fax:408-624-4545
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58754122300000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X2210XDental ProvidersDentistOrofacial Pain