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General NPI Number Information
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NPI Number | 1003590662
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Entity Type | Individual
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Provider Name | HARDIK JAYESH SHAH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9813 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-4113
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Country | US
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Telephone | 512-593-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 10608 PLUCHEA CV
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City | AUSTIN
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State | TX
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Zip | 78733-5721
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Country | US
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Telephone | 909-751-5291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39639
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License Number State | TX
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