Provider Demographics
NPI:1568678043
Name:SHROFF, BANSRI SUNIL (DMD)
Entity Type:Individual
Prefix:
First Name:BANSRI
Middle Name:SUNIL
Last Name:SHROFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 SILSBY RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3303
Mailing Address - Country:US
Mailing Address - Phone:216-320-2920
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST
Practice Address - Street 2:STE. 250
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3626
Practice Address - Country:US
Practice Address - Phone:330-836-4467
Practice Address - Fax:330-864-8140
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice