Provider Demographics
NPI:1104904531
Name:SHAH, RAOUL RASHMI (DDS)
Entity type:Individual
Prefix:MR
First Name:RAOUL
Middle Name:RASHMI
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 1:1241 MERIDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-266-6144
Mailing Address - Fax:408-676-4443
Practice Address - Street 1:1241 MERIDIAN AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-266-6144
Practice Address - Fax:408-676-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice