MEDICARE: DR. KAVI HARESH 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	122300000X	Dentist	057528	NY

General Provider Information

NPI Number	:	1609285436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVI HARESH SHAH DMD

Provider Business Mailing Address
First Line	:	25710 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-343-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	25710 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-343-7700
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/14/2014

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