Provider Demographics
NPI:1508095068
Name:MAULIK SHAH DENTAL CORPORATION
Entity Type:Organization
Organization Name:MAULIK SHAH DENTAL CORPORATION
Other - Org Name:ACCORD DENTAL,PRACTICE OF MAULIK SHAH DENTAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-247-3307
Mailing Address - Street 1:4116 DRAGOO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1860
Mailing Address - Country:US
Mailing Address - Phone:209-247-3307
Mailing Address - Fax:
Practice Address - Street 1:4120 DALE RD
Practice Address - Street 2:SUITE J-6
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9232
Practice Address - Country:US
Practice Address - Phone:209-247-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty