Provider Demographics
NPI:1205049384
Name:SHAH, SHASHIKANT (BDS)
Entity type:Individual
Prefix:DR
First Name:SHASHIKANT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S INDUSTRIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7421
Mailing Address - Country:US
Mailing Address - Phone:386-775-8737
Mailing Address - Fax:386-775-3757
Practice Address - Street 1:123 S INDUSTRIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7421
Practice Address - Country:US
Practice Address - Phone:386-775-8737
Practice Address - Fax:386-775-3757
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN84621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice