Provider Demographics
NPI:1750499182
Name:SHAH, DHAVAL (DDS MDS)
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28942 GREENSPOT RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-4423
Mailing Address - Country:US
Mailing Address - Phone:909-864-2002
Mailing Address - Fax:909-864-2322
Practice Address - Street 1:28942 GREENSPOT RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-4423
Practice Address - Country:US
Practice Address - Phone:909-864-2002
Practice Address - Fax:909-864-2322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist