MEDICARE: NEAL SHAH D.D.S.

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	DN013903	GA

General Provider Information

NPI Number	:	1699907097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL SHAH D.D.S.

Provider Business Mailing Address
First Line	:	1175 PEACHTREE ST STE 1204
Second Line	:	100 COLONY SQUARE
City	:	ATLANTA
State	:	GA
Zip	:	30361-6213
Country	:	US
Telephone Number	:	404-872-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 PEACHTREE ST STE 1204
Second Line	:	100 COLONY SQUARE
City	:	ATLANTA
State	:	GA
Zip	:	30361-6213
Country	:	US
Telephone Number	:	404-872-2097
Fax Number	:

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	02/16/2011

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