Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019029123 | IL |
Y | 122300000X | Dentist | DS039259 | PA |
NPI | 1003161613 |
---|---|
Provider Name | Dhaval Shah |
First Address | Souderton, PA 18964-2292 |
Second Address | Limerick, PA 19468-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 16/08/2013 |