Provider Demographics
NPI:1457032807
Name:KINNAR R SHAH DMD PA
Entity Type:Organization
Organization Name:KINNAR R SHAH DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINNAR
Authorized Official - Middle Name:RAMESHCHANDRA
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-385-1003
Mailing Address - Street 1:30 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9115
Mailing Address - Country:US
Mailing Address - Phone:215-385-1003
Mailing Address - Fax:
Practice Address - Street 1:121 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9541
Practice Address - Country:US
Practice Address - Phone:352-735-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty