Provider Demographics
NPI:1518568138
Name:SHAH, RAIME (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RAIME
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 TOWNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7538
Mailing Address - Country:US
Mailing Address - Phone:650-550-0056
Mailing Address - Fax:
Practice Address - Street 1:1416 TOWNVIEW LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7538
Practice Address - Country:US
Practice Address - Phone:707-525-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105763122300000X
CADDS1057631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist