MEDICARE: MALAV B. 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	1223G0001X	General Practice Dentistry	4244	WV

General Provider Information

NPI Number	:	1578910311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAV B. SHAH DDS

Provider Business Mailing Address
First Line	:	1616 13TH AVE
Second Line	:	SUITE 200
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3840
Country	:	US
Telephone Number	:	304-691-1246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 13TH AVE
Second Line	:	SUITE 200
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3840
Country	:	US
Telephone Number	:	304-691-1246
Fax Number	:

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	11/15/2021

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