Provider Demographics
NPI:1124457924
Name:SHAH, DHARA (DMD)
Entity type:Individual
Prefix:DR
First Name:DHARA
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 1:124 NEWBURY ST STE D
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4067
Mailing Address - Country:US
Mailing Address - Phone:978-278-5478
Mailing Address - Fax:978-278-5714
Practice Address - Street 1:113 MAIN ST STE 7AND7A
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1621
Practice Address - Country:US
Practice Address - Phone:508-529-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0099598122300000X
CT112321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist