Provider Demographics
NPI:1598951972
Name:TAYDE, SHITAL (DMD)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:
Last Name:TAYDE
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 1:12380 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4016
Mailing Address - Country:US
Mailing Address - Phone:303-421-7000
Mailing Address - Fax:303-421-1687
Practice Address - Street 1:12380 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4016
Practice Address - Country:US
Practice Address - Phone:303-421-7000
Practice Address - Fax:303-421-1687
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice