Provider Demographics
NPI:1932285384
Name:SHAH, RAJNIKANT K (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:RAJNIKANT
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3005
Mailing Address - Country:US
Mailing Address - Phone:610-539-6550
Mailing Address - Fax:610-539-4751
Practice Address - Street 1:2121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3005
Practice Address - Country:US
Practice Address - Phone:610-539-6550
Practice Address - Fax:610-539-4751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 20620-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS020620-LOtherDENTIST