Provider Demographics
NPI:1477121119
Name:SHAH, MILONIBEN KETAN
Entity Type:Individual
Prefix:DR
First Name:MILONIBEN
Middle Name:KETAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MILONI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:444 WARREN ST APT 755
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-7204
Mailing Address - Country:US
Mailing Address - Phone:201-724-8754
Mailing Address - Fax:
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2654
Practice Address - Country:US
Practice Address - Phone:732-639-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02975200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist