Provider Demographics
NPI:1760010359
Name:SHAH, MEESHAL (DMD)
Entity type:Individual
Prefix:MISS
First Name:MEESHAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 LINCOLN HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3213
Mailing Address - Country:US
Mailing Address - Phone:732-724-0805
Mailing Address - Fax:732-724-0878
Practice Address - Street 1:1914 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-724-0805
Practice Address - Fax:732-724-0878
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028439001223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program