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General NPI Number Information
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NPI Number | 1740524586
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Entity Type | Individual
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Provider Name | CHINTAN N SHAH
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Gender | Male
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Dates
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Enumeration Date | 11/17/2012
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Last Update Date | 01/05/2019
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Provider Practice Location Address
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Address Line | 15723 N 102ND ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-8616
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Country | US
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Telephone | 773-680-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 15723 N 102ND ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-8616
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Country | US
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Telephone | 773-680-6090
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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 | 2901020580
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D9106
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License Number State | AZ
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