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General NPI Number Information
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NPI Number | 1053768432
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Entity Type | Individual
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Provider Name | SHARVIL SHAH DMD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 07/31/2016
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Provider Practice Location Address
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Address Line | 28609 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-4105
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Country | US
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Telephone | 586-751-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 3091 DEER CREEK CT
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City | ANN ARBOR
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State | MI
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Zip | 48105-9664
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Country | US
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Telephone | 734-277-7495
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901022046
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License Number State | MI
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