Provider Demographics
NPI:1760524961
Name:SHAH, PRITI G (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:G
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 CRANBURY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3000
Mailing Address - Country:US
Mailing Address - Phone:732-390-7645
Mailing Address - Fax:732-390-7345
Practice Address - Street 1:385 CRANBURY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3000
Practice Address - Country:US
Practice Address - Phone:732-390-7645
Practice Address - Fax:732-390-7345
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021768001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9039902Medicaid