Provider Demographics
NPI:1942657911
Name:SHAH, PRACHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRACHI
Middle Name:
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 1:5 SCHINDLER DR S
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3304
Mailing Address - Country:US
Mailing Address - Phone:732-789-8166
Mailing Address - Fax:
Practice Address - Street 1:4400 ROUTE 9 S STE 3200
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4210
Practice Address - Country:US
Practice Address - Phone:732-702-2787
Practice Address - Fax:732-702-2448
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02629700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist