Healthcare Provider Details

I. General information

NPI: 1073274908
Provider Name (Legal Business Name): VIDHI PANDYA SHAH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MARLTON PIKE E
CHERRY HILL NJ
08003-2014
US

IV. Provider business mailing address

1 JEFFREY WAY
PISCATAWAY NJ
08854-5235
US

V. Phone/Fax

Practice location:
  • Phone: 846-444-5495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI03017300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: