Provider Demographics
NPI:1598324113
Name:SHAH, DHAVAL YOGESHKUMAR (DMD)
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:YOGESHKUMAR
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 1:8206 PHILIPS HWY.
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-425-1212
Mailing Address - Fax:
Practice Address - Street 1:8206 PHILIPS HWY.
Practice Address - Street 2:SUITE 21
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-425-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist