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General NPI Number Information
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NPI Number | 1679968465
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Entity Type | Individual
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Provider Name | DEEP I. SHAH DMD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 1073 OAK ST
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City | PITTSTON
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State | PA
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Zip | 18640-3716
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Country | US
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Telephone | 570-654-4141
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Fax | 570-654-2150
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Provider Business Mailing Address
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Address Line | 625 CORNFIELD WAY APT. 201
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City | DALLAS
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State | PA
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Zip | 18612-7215
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Country | US
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Telephone | 215-272-7446
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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 | DS040290
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS040290
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License Number State | PA
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