Provider Demographics
NPI:1851734529
Name:SHAH, PURVY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PURVY
Middle Name:A
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 1:119 COLUMBIA TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2906
Mailing Address - Country:US
Mailing Address - Phone:973-210-4910
Mailing Address - Fax:
Practice Address - Street 1:119 COLUMBIA TPKE STE 201
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2906
Practice Address - Country:US
Practice Address - Phone:973-210-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025330001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics