Provider Demographics
NPI:1710031935
Name:SHAH, RAJNI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJNI
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 ACADEMY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1126
Mailing Address - Country:US
Mailing Address - Phone:215-637-7474
Mailing Address - Fax:215-637-4408
Practice Address - Street 1:10431 ACADEMY RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1126
Practice Address - Country:US
Practice Address - Phone:215-637-7474
Practice Address - Fax:215-637-4408
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019787L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice