MEDICARE: TAKSH NIPOON SHAH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DSO43605	PA

General Provider Information

NPI Number	:	1033841713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKSH NIPOON SHAH DMD

Provider Business Mailing Address
First Line	:	2100 HADDONFIELD RD APT 10203
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1242
Country	:	US
Telephone Number	:	201-724-7014
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 S 3RD ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2109
Country	:	US
Telephone Number	:	610-377-5948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	04/13/2026

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