Provider Demographics
NPI:1528367190
Name:SHAH, NISHIT (DMD)
Entity Type:Individual
Prefix:DR
First Name:NISHIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CENTER SQUARE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1864
Mailing Address - Country:US
Mailing Address - Phone:856-294-6767
Mailing Address - Fax:
Practice Address - Street 1:120 CENTER SQUARE RD STE 205
Practice Address - Street 2:
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1864
Practice Address - Country:US
Practice Address - Phone:856-294-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02471600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist