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General NPI Number Information
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NPI Number | 1245669977
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Entity Type | Individual
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Provider Name | HARSH SHAH
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Gender | Male
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 2200 PRESERVE AVE W APT 2231
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City | PORT ROYAL
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State | SC
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Zip | 29935-2524
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Country | US
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Telephone | 810-357-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PRESERVE AVE W APT 2231
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City | PORT ROYAL
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State | SC
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Zip | 29935-2524
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Country | US
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Telephone |
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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 | 30.023886
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License Number State | OH
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