Provider Demographics
NPI:1316948672
Name:SHAH, BHAVNA (DDS)
Entity type:Individual
Prefix:MRS
First Name:BHAVNA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 ROYAL TOWER WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-1673
Mailing Address - Country:US
Mailing Address - Phone:919-467-4254
Mailing Address - Fax:919-363-3933
Practice Address - Street 1:617 ROYAL TOWE WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-467-4254
Practice Address - Fax:919-363-3933
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice