Provider Demographics
NPI:1720308828
Name:SHAH, ROHINI KETAN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ROHINI
Middle Name:KETAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:ROHINI
Other - Middle Name:BABURAO
Other - Last Name:KHARAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS, MDS
Mailing Address - Street 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:
Practice Address - Street 1:3438 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2648
Practice Address - Country:US
Practice Address - Phone:502-366-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice