Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN23941 | FL |
NPI | 1043710403 |
---|---|
Provider Name | Ruchi Shukla |
First Address | Plant City, FL 33563-2972 |
Second Address | Plant City, FL 33563-2972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 02/07/2020 |