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General NPI Number Information
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NPI Number | 1649651670
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Entity Type | Individual
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Provider Name | TUSHIN ATULKUMAR SHAH
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Gender | Male
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 229 E CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-5207
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Country | US
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Telephone | 860-643-0688
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Fax | 860-432-8495
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Provider Business Mailing Address
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Address Line | 229 E CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-5207
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Country | US
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Telephone | 724-261-1034
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Fax | 860-432-8495
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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 | 11626
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | DN1857506
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License Number State | MA
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