Provider Demographics
NPI:1427223650
Name:MAMTA SHAH, P.C.
Entity type:Organization
Organization Name:MAMTA SHAH, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-986-2034
Mailing Address - Street 1:1100 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4152
Mailing Address - Country:US
Mailing Address - Phone:732-562-1111
Mailing Address - Fax:732-875-0582
Practice Address - Street 1:1100 CENTENNIAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4152
Practice Address - Country:US
Practice Address - Phone:732-562-1111
Practice Address - Fax:732-875-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02123400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty