Provider Demographics
NPI:1285704056
Name:SHAH, ADVAIT V (DMD)
Entity type:Individual
Prefix:DR
First Name:ADVAIT
Middle Name:V
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GREENMEADOW DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3200
Mailing Address - Country:US
Mailing Address - Phone:410-308-9955
Mailing Address - Fax:410-308-9980
Practice Address - Street 1:16 GREENMEADOW DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3200
Practice Address - Country:US
Practice Address - Phone:410-308-9955
Practice Address - Fax:410-308-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053576122300000X
MD15215122300000X
VA0401413923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101468810Medicare ID - Type Unspecified
PA101468810Medicaid