MEDICARE: DR. MAITRI DIVYANGKUMAR SHAH DMD, MHA, BDS

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	DS043643	PA

General Provider Information

NPI Number	:	1457090383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAITRI DIVYANGKUMAR SHAH DMD, MHA, BDS

Provider Business Mailing Address
First Line	:	672 MAIN ST
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1679
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 MAIN ST
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1679
Country	:	US
Telephone Number	:	215-513-9533
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	04/05/2025

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