Healthcare Provider Details

I. General information

NPI: 1366556037
Provider Name (Legal Business Name): TIKA SHAH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIKA TIKA SHAH DMD

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW 167TH ST STE 109
MIAMI GARDENS FL
33056-4838
US

IV. Provider business mailing address

1180 N FEDERAL HWY UNIT 702
FORT LAUDERDALE FL
33304-1466
US

V. Phone/Fax

Practice location:
  • Phone: 305-474-1800
  • Fax:
Mailing address:
  • Phone: 314-504-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number31050
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number119
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2000159262
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: