MEDICARE: DR. SONAL S SHAH DDS

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	052700	NY
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	S1-27C	NV

General Provider Information

NPI Number	:	1265620181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONAL S SHAH DDS

Provider Business Mailing Address
First Line	:	725 S HUALAPAI WAY APT 2001
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8838
Country	:	US
Telephone Number	:	713-542-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2335
Country	:	US
Telephone Number	:	702-774-2516
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/25/2021

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