Provider Demographics
NPI:1770658379
Name:SHAH, PURVI KEYUSH (DDS)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:KEYUSH
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 1:805 WALES DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5542
Mailing Address - Country:US
Mailing Address - Phone:916-817-8900
Mailing Address - Fax:916-817-8955
Practice Address - Street 1:805 WALES DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5542
Practice Address - Country:US
Practice Address - Phone:916-817-8900
Practice Address - Fax:916-817-8955
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice