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General NPI Number Information
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NPI Number | 1164803235
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Entity Type | Organization
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Legal Business Name | JYOTI R. SHAH, DDS INC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 7526 E 82ND ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1462
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Country | US
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Telephone | 317-915-0787
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Fax | 866-941-4941
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Provider Business Mailing Address
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Address Line | 7526 E 82ND ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1462
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Country | US
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Telephone | 317-915-0787
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Fax | 866-941-4941
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. JYOTI R SHAH
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Credential | D.D.S.
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Telephone | 317-915-0787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12010068
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License Number State | IN
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