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General NPI Number Information
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NPI Number | 1427223650
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Entity Type | Organization
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Legal Business Name | MAMTA SHAH, P.C.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1100 CENTENNIAL AVE SUITE 101
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4152
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Country | US
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Telephone | 732-562-1111
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Fax | 732-875-0582
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Provider Business Mailing Address
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Address Line | 1100 CENTENNIAL AVE SUITE 101
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4152
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Country | US
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Telephone | 732-562-1111
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Fax | 732-875-0582
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAMTA SHAH
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Credential | DDS
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Telephone | 732-986-2034
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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 | DI02123400
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License Number State | NJ
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