Healthcare Provider Details

I. General information

NPI: 1265620181
Provider Name (Legal Business Name): SONAL S SHAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W CHARLESTON BLVD
LAS VEGAS NV
89102-2335
US

IV. Provider business mailing address

725 S HUALAPAI WAY APT 2001
LAS VEGAS NV
89145-8838
US

V. Phone/Fax

Practice location:
  • Phone: 702-774-2516
  • Fax:
Mailing address:
  • Phone: 713-542-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number052700
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberS1-27C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: