Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 10984 | CT |
N | 1223P0221X | Pediatric Dentist | 22DI02526900 | NJ |
Y | 1223P0221X | Pediatric Dentist | DS039945 | PA |
NPI | 1043654098 |
---|---|
Provider Name | Dr. Anil Shah |
First Address | Wayne, PA 19087-4188 |
Second Address | Wayne, PA 19087-4188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 03/09/2020 |