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General NPI Number Information
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NPI Number | 1043411572
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Entity Type | Individual
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Provider Name | NAMITA PRASHANT SHAH DMD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 447 ROUTE 10 E SUITE #3
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City | RANDOLPH
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State | NJ
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Zip | 07869-2132
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Country | US
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Telephone | 973-537-7500
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Fax | 973-537-7400
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Provider Business Mailing Address
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Address Line | 1705 WINDSOR CT
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City | DENVILLE
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State | NJ
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Zip | 07834-3449
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Country | US
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Telephone | 973-537-8085
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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 | 22DI01915000
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License Number State | NJ
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