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General NPI Number Information
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NPI Number | 1841722337
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Entity Type | Organization
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Legal Business Name | SHAH JOLLY DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1761 E CAPITOL EXPY
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City | SAN JOSE
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State | CA
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Zip | 95121-1561
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Country | US
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Telephone | 408-223-2500
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Fax | 408-223-5525
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Provider Business Mailing Address
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Address Line | 44240 REVERE PL
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City | FREMONT
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State | CA
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Zip | 94539-5902
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Country | US
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Telephone | 510-520-0136
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | JOLLY SHAH
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Credential | DDS
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Telephone | 408-223-2500
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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 | 44775
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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