MEDICARE: DR. CHINTAN SHUKLA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS045171	PA

General Provider Information

NPI Number	:	1134744063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINTAN SHUKLA DMD

Provider Business Mailing Address
First Line	:	304 SIP AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6511
Country	:	US
Telephone Number	:	973-668-3720
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 BALTIMORE PIKE
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3629
Country	:	US
Telephone Number	:	610-605-2835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	08/13/2025

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