Provider Demographics
NPI:1811548969
Name:SHAH, PRACHI H (DDS)
Entity Type:Individual
Prefix:MRS
First Name:PRACHI
Middle Name:H
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 1:76 CEDAR ST UNIT 704
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-4107
Mailing Address - Country:US
Mailing Address - Phone:650-495-2182
Mailing Address - Fax:
Practice Address - Street 1:7935 216TH ST SW STE D
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7941
Practice Address - Country:US
Practice Address - Phone:425-774-5511
Practice Address - Fax:425-774-5590
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60959377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist