Provider Demographics
NPI:1750806733
Name:SHAH, HETAL
Entity type:Individual
Prefix:
First Name:HETAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HETAL
Other - Middle Name:
Other - Last Name:DOSHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1523 N VASCO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9035
Mailing Address - Country:US
Mailing Address - Phone:925-373-4855
Mailing Address - Fax:
Practice Address - Street 1:1523 N VASCO RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9035
Practice Address - Country:US
Practice Address - Phone:925-373-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026819001223G0001X
CA1033041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice