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General NPI Number Information
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NPI Number | 1134386907
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL SPECIALTIES
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 905 ALLWOOD ROAD SUITE 107
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 973-777-5353
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Fax | 973-249-0016
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Provider Business Mailing Address
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Address Line | 905 ALLWOOD ROAD SUITE 107
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 973-777-5353
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Fax | 973-249-0016
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SHWETA A SHAH
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Credential | DDS
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Telephone | 973-766-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D21821
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License Number State | NJ
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