Provider Demographics
NPI:1760010359
Name:SHAH, MEESHAL (DMD)
Entity Type:Individual
Prefix:MISS
First Name:MEESHAL
Middle Name:
Last Name:SHAH
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 1:3333 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2691
Mailing Address - Country:US
Mailing Address - Phone:732-679-6666
Mailing Address - Fax:732-679-6676
Practice Address - Street 1:3333 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2691
Practice Address - Country:US
Practice Address - Phone:732-679-6666
Practice Address - Fax:732-679-6666
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI028439001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program