Provider Demographics
NPI:1336620350
Name:DAVE, SHIVANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:DAVE
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 1:606 W 57TH ST APT 823
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1002
Mailing Address - Country:US
Mailing Address - Phone:704-989-2709
Mailing Address - Fax:
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2428
Practice Address - Country:US
Practice Address - Phone:732-226-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027200001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice