Healthcare Provider Details

I. General information

NPI: 1669180204
Provider Name (Legal Business Name): SHREYA SHAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8985 TELEGRAPH RD
TAYLOR MI
48180-2366
US

IV. Provider business mailing address

4426 3RD ST
DETROIT MI
48201-1134
US

V. Phone/Fax

Practice location:
  • Phone: 313-299-7870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603264
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: