Provider Demographics
NPI:1053573063
Name:SHAH, BHAVIN S (DDS)
Entity type:Individual
Prefix:
First Name:BHAVIN
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1825
Mailing Address - Country:US
Mailing Address - Phone:732-491-6438
Mailing Address - Fax:570-888-5701
Practice Address - Street 1:408 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1825
Practice Address - Country:US
Practice Address - Phone:732-491-6438
Practice Address - Fax:570-888-5607
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222301223G0001X
PADS0375531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice