Provider Demographics
NPI:1831328194
Name:SHAH, EKTA ANKUR (DDS)
Entity type:Individual
Prefix:MRS
First Name:EKTA
Middle Name:ANKUR
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 CRISANTO AVE
Mailing Address - Street 2:APT. 326
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1841
Mailing Address - Country:US
Mailing Address - Phone:408-835-5436
Mailing Address - Fax:800-459-3521
Practice Address - Street 1:1929 CRISANTO AVE
Practice Address - Street 2:APT. 326
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1841
Practice Address - Country:US
Practice Address - Phone:408-835-5436
Practice Address - Fax:800-459-3521
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice