Provider Demographics
NPI:1063214807
Name:SHAH, MOLINA (DDS)
Entity type:Individual
Prefix:
First Name:MOLINA
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 BALLANTYNE COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1415
Mailing Address - Country:US
Mailing Address - Phone:704-615-6479
Mailing Address - Fax:
Practice Address - Street 1:722 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3727
Practice Address - Country:US
Practice Address - Phone:212-305-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program