Healthcare Provider Details

I. General information

NPI: 1801864848
Provider Name (Legal Business Name): VARSHA DIVECHA SHAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 GRAND CONCOURSE PEDIATRIC DENTIST
BRONX NY
10468-1428
US

IV. Provider business mailing address

18 WHITEWOOD RD
WHITE PLAINS NY
10603-1137
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-0998
  • Fax:
Mailing address:
  • Phone: 914-592-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: