Provider Demographics
NPI:1720415607
Name:ZAVERI SHAH, PRANJLI VISHAL
Entity Type:Individual
Prefix:
First Name:PRANJLI
Middle Name:VISHAL
Last Name:ZAVERI SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1131
Mailing Address - Country:US
Mailing Address - Phone:410-300-6263
Mailing Address - Fax:
Practice Address - Street 1:433 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4909
Practice Address - Country:US
Practice Address - Phone:973-482-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025471001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice