Provider Demographics
NPI:1043654098
Name:SHAH, ANIL (DDS)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
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 1:94 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4188
Mailing Address - Country:US
Mailing Address - Phone:201-248-1286
Mailing Address - Fax:
Practice Address - Street 1:94 PARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4188
Practice Address - Country:US
Practice Address - Phone:201-248-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025269001223P0221X
CT109841223P0221X
PADS0399451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry