Provider Demographics
NPI:1750721627
Name:SHAH, NISARG ASHWINBHAI (DDS)
Entity type:Individual
Prefix:
First Name:NISARG
Middle Name:ASHWINBHAI
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 N MACARTHUR BLVD
Mailing Address - Street 2:APT 3034
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3782
Mailing Address - Country:US
Mailing Address - Phone:916-996-5022
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY
Practice Address - Street 2:SUITE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7781
Practice Address - Country:US
Practice Address - Phone:972-663-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist