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General NPI Number Information
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NPI Number | 1093973356
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Entity Type | Individual
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Provider Name | KRUPALI SHAH DDS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 120 BETHPAGE RD STE 310
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City | HICKSVILLE
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State | NY
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Zip | 11801-1515
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Country | US
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Telephone | 773-407-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WILLETS DR
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City | SYOSSET
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State | NY
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Zip | 11791-3913
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Country | US
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Telephone | 773-407-1004
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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 | 019027638
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License Number State | IL
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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 | 056445
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License Number State | NY
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