Provider Demographics
NPI:1710432463
Name:RUPAL N. SHAH DDS INC
Entity Type:Organization
Organization Name:RUPAL N. SHAH DDS INC
Other - Org Name:GROVEHILL FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPAL
Authorized Official - Middle Name:NIRAV
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-731-7465
Mailing Address - Street 1:4658 MACBETH CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2034
Mailing Address - Country:US
Mailing Address - Phone:510-731-7465
Mailing Address - Fax:
Practice Address - Street 1:21471 FOOTHILL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2169
Practice Address - Country:US
Practice Address - Phone:510-573-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty