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General NPI Number Information
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NPI Number | 1366556037
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Entity Type | Individual
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Provider Name | TIKA SHAH D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1825 NW 167TH ST STE 109
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-4838
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Country | US
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Telephone | 305-474-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 N FEDERAL HWY UNIT 702
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1466
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Country | US
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Telephone | 314-504-8092
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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 | 31050
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 119
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2000159262
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License Number State | MO
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