MEDICARE: DR. OJAS V SHAH D.D.S.

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	0556901	NY

General Provider Information

NPI Number	:	1447530969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OJAS V SHAH D.D.S.

Provider Business Mailing Address
First Line	:	1719 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1356
Country	:	US
Telephone Number	:	914-310-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1356
Country	:	US
Telephone Number	:	914-310-1609
Fax Number	:

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

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	12/27/2016

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