MEDICARE: DR. VIRAL L SHAH DDS

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	009782	CT
2	1223G0001X	General Practice Dentistry	009782	CT

General Provider Information

NPI Number	:	1720257264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRAL L SHAH DDS

Provider Business Mailing Address
First Line	:	54 MAIN ST STE F
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:	203-797-0822

Provider Business Practice Location Address
First Line	:	54 MAIN ST STE F
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:	203-797-0822

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	06/23/2014

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