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General NPI Number Information
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NPI Number | 1851605372
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Entity Type | Individual
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Provider Name | ANKITA SHAH D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 194 FRANCISCO LN STE. 112
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City | FREMONT
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State | CA
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Zip | 94539-7926
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Country | US
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Telephone | 510-659-0130
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Fax | 510-659-0177
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Provider Business Mailing Address
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Address Line | 39440 CIVIC CENTER DR APT. 408
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City | FREMONT
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State | CA
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Zip | 94538-3285
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Country | US
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Telephone | 812-560-8056
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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 | 59493
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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 | 12011405A
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License Number State | IN
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