Provider Demographics
NPI:1467674309
Name:SHAH, ADITI (DDS)
Entity type:Individual
Prefix:DR
First Name:ADITI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6069
Mailing Address - Country:US
Mailing Address - Phone:817-809-4445
Mailing Address - Fax:817-541-4449
Practice Address - Street 1:5611 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6069
Practice Address - Country:US
Practice Address - Phone:817-809-4445
Practice Address - Fax:817-541-4449
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice