=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851778773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAH AND KARIA DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2015
-----------------------------------------------------
Last Update Date | 04/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2680 N 1ST ST STE 100
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95134-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-943-9443
-----------------------------------------------------
Fax | 408-943-8929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2680 NORTH FIRST STREET #100
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-943-9443
-----------------------------------------------------
Fax | 408-943-8929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VANDANA KARIA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 408-813-4733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 56997
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------