Healthcare Provider Details

I. General information

NPI: 1780090720
Provider Name (Legal Business Name): ANIL SHAH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N 5TH STREET HWY
READING PA
19605-2802
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 215-643-9400
  • Fax: 215-646-6166
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039945
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ANIL SHAH
Title or Position: DENTIST
Credential: DDS
Phone: 201-248-1286