Healthcare Provider Details

I. General information

NPI: 1972486371
Provider Name (Legal Business Name): ANUP H SHAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG RAF LAKENHEATH, APO, AE, 09461
APO AE
09461
US

IV. Provider business mailing address

48TH MDG RAF LAKENHEATH, APO, AE, 09461
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045385
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: