Provider Demographics
NPI:1649495615
Name:BLOOR, PRITI SHAH (DDS)
Entity type:Individual
Prefix:MRS
First Name:PRITI
Middle Name:SHAH
Last Name:BLOOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PRITI
Other - Middle Name:N
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2500 HOSPITAL BOULEVARD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-663-4435
Mailing Address - Fax:770-663-0489
Practice Address - Street 1:2500 HOSPITAL BOULEVARD
Practice Address - Street 2:SUITE 320
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-663-4435
Practice Address - Fax:770-663-0489
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012161122300000X
CA41038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist