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: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355B FACULTY DR
UNITED STATES AIR FORCE ACAD CO
80840-1802
US

IV. Provider business mailing address

2355B FACULTY DR
UNITED STATES AIR FORCE ACAD CO
80840-1802
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5192
  • Fax:
Mailing address:
  • Phone: 719-333-5192
  • 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: