Healthcare Provider Details

I. General information

NPI: 1154165520
Provider Name (Legal Business Name): GEET SHUKLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 NORWICH RD
PLAINFIELD CT
06374-1734
US

IV. Provider business mailing address

721 NORWICH RD
PLAINFIELD CT
06374-1734
US

V. Phone/Fax

Practice location:
  • Phone: 860-546-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0000
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: