Healthcare Provider Details

I. General information

NPI: 1083707996
Provider Name (Legal Business Name): PAULOMI R SHAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0297
US

IV. Provider business mailing address

800 ROSE ST D104
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6400
  • Fax:
Mailing address:
  • Phone: 859-323-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number014202
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: