Provider Demographics
NPI:1154388643
Name:SHAH, SONAL (BDS, DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:BDS, DDS, MS
Other - Prefix:DR
Other - First Name:SONAL
Other - Middle Name:
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS, DDS
Mailing Address - Street 1:11662 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4588
Mailing Address - Country:US
Mailing Address - Phone:586-754-6300
Mailing Address - Fax:586-754-6407
Practice Address - Street 1:11662 MARTIN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4588
Practice Address - Country:US
Practice Address - Phone:586-754-6300
Practice Address - Fax:586-754-6407
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI154631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry