Provider Demographics
NPI:1518307404
Name:SHAH, CHINTAN PIYUSH (DDS)
Entity Type:Individual
Prefix:
First Name:CHINTAN
Middle Name:PIYUSH
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1569
Mailing Address - Country:US
Mailing Address - Phone:810-742-6060
Mailing Address - Fax:810-742-3022
Practice Address - Street 1:5136 DAVISON RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1569
Practice Address - Country:US
Practice Address - Phone:810-742-6060
Practice Address - Fax:810-742-3022
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2901021058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program