Healthcare Provider Details

I. General information

NPI: 1346508785
Provider Name (Legal Business Name): KAJEL SHAH D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6443 W 10TH ST STE 204
INDIANAPOLIS IN
46214-6502
US

IV. Provider business mailing address

1283 GOLDFINCH DR
CARMEL IN
46032-1189
US

V. Phone/Fax

Practice location:
  • Phone: 317-247-9512
  • Fax:
Mailing address:
  • Phone: 727-686-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12014148A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: