MEDICARE: SHEMAL 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	D010336	AZ

General Provider Information

NPI Number	:	1508423583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEMAL SHUKLA DMD

Provider Business Mailing Address
First Line	:	3033 N CENTRAL AVE STE 145
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2808
Country	:	US
Telephone Number	:	623-583-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	15317 W BELL RD STE 108
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3901
Country	:	US
Telephone Number	:	877-809-5092
Fax Number	:

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

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	02/16/2021

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