Healthcare Provider Details

I. General information

NPI: 1275706715
Provider Name (Legal Business Name): VARSHA D SHAH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 GRAND CONCOURSE
BRONX NY
10468-1428
US

IV. Provider business mailing address

3005 GRAND CONCOURSE
BRONX NY
10468-1428
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-0998
  • Fax: 718-933-0110
Mailing address:
  • Phone: 718-933-0998
  • Fax: 718-933-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number033490
License Number StateNY

VIII. Authorized Official

Name: DR. VARSHA D SHAH
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-933-0998