Provider Demographics
NPI:1366556037
Name:SHAH, TIKA (DMD)
Entity type:Individual
Prefix:
First Name:TIKA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TIKA
Other - Middle Name:TIKA
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1180 N FEDERAL HWY UNIT 702
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1466
Mailing Address - Country:US
Mailing Address - Phone:314-504-8092
Mailing Address - Fax:
Practice Address - Street 1:1825 NW 167TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-474-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31050122300000X
FL1191223D0001X
MO2000159262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119830700Medicaid
MO409036811Medicaid
MO000025690Medicare PIN