Healthcare Provider Details

I. General information

NPI: 1790570745
Provider Name (Legal Business Name): MEET RAXITKUMAR SHAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 2ND ST
HACKENSACK NJ
07601-2050
US

IV. Provider business mailing address

1998 COUNTRY TRCE
TOMS RIVER NJ
08753-1448
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2111
  • Fax:
Mailing address:
  • Phone: 848-226-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: