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General NPI Number Information
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NPI Number | 1700193596
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Entity Type | Individual
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Provider Name | VISHAL SHAH DMD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 4860 RUCKER RD STE 3
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City | MONETA
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State | VA
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Zip | 24121-5281
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Country | US
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Telephone | 540-297-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 9409 ENGLEFIELD CT
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3173
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Country | US
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Telephone | 703-314-9994
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0442000114
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License Number State | VA
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