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General NPI Number Information
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NPI Number | 1710432463
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Entity Type | Organization
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Legal Business Name | RUPAL N. SHAH DDS INC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 21471 FOOTHILL BLVD SUITE E
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City | HAYWARD
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State | CA
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Zip | 94541-2169
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Country | US
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Telephone | 510-573-6175
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Fax |
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Provider Business Mailing Address
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Address Line | 4658 MACBETH CT
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City | FREMONT
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State | CA
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Zip | 94555-2034
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Country | US
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Telephone | 510-731-7465
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RUPAL NIRAV SHAH
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Credential | DDS
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Telephone | 510-731-7465
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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 | 58658
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License Number State | CA
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