Provider Demographics
NPI:1518011907
Name:SHAH, PAYAL DHIRENDRA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:PAYAL
Middle Name:DHIRENDRA
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 1:1700 N 1ST ST
Mailing Address - Street 2:#350
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2919
Practice Address - Country:US
Practice Address - Phone:408-971-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist