Provider Demographics
NPI:1851453542
Name:SHAH, MAULIK MAHENDRABHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAULIK
Middle Name:MAHENDRABHAI
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 DRAGOO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1860
Mailing Address - Country:US
Mailing Address - Phone:209-247-3307
Mailing Address - Fax:
Practice Address - Street 1:2603 PATTERSON RD STE 5
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-315-6300
Practice Address - Fax:209-315-6363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist