Provider Demographics
NPI:1568529907
Name:SHELADIA, MANISH VALLABH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:VALLABH
Last Name:SHELADIA
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 1:825 MAJESTIC CT
Mailing Address - Street 2:STE. C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5186
Mailing Address - Country:US
Mailing Address - Phone:704-864-6721
Mailing Address - Fax:704-864-1175
Practice Address - Street 1:825 MAJESTIC CT
Practice Address - Street 2:STE. C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5186
Practice Address - Country:US
Practice Address - Phone:704-864-6721
Practice Address - Fax:704-864-1175
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC084751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice