Provider Demographics
NPI:1740524586
Name:SHAH, CHINTAN N
Entity type:Individual
Prefix:
First Name:CHINTAN
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15723 N 102ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8616
Mailing Address - Country:US
Mailing Address - Phone:773-680-6090
Mailing Address - Fax:
Practice Address - Street 1:15723 N 102ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8616
Practice Address - Country:US
Practice Address - Phone:773-680-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-17
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020580122300000X
AZD91061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist