Provider Demographics
NPI:1114752441
Name:SHAH, JINESH V (DDS)
Entity type:Individual
Prefix:DR
First Name:JINESH
Middle Name:V
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:N14W23755 STONE RIDGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1684
Mailing Address - Country:US
Mailing Address - Phone:847-942-8142
Mailing Address - Fax:
Practice Address - Street 1:N14W23755 STONE RIDGE DR STE 260
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1684
Practice Address - Country:US
Practice Address - Phone:847-942-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001635-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist