Healthcare Provider Details

I. General information

NPI: 1760648935
Provider Name (Legal Business Name): PUJA SHAH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 N EL CAMINO REAL
ENCINITAS CA
92024-1334
US

IV. Provider business mailing address

1084 N EL CAMINO REAL # B421
ENCINITAS CA
92024-1334
US

V. Phone/Fax

Practice location:
  • Phone: 516-528-6418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number054018
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: