Provider Demographics
NPI:1720257264
Name:SHAH, VIRAL L (DDS)
Entity type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:L
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-3009
Mailing Address - Country:US
Mailing Address - Phone:203-790-0111
Mailing Address - Fax:203-797-0822
Practice Address - Street 1:54 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-3009
Practice Address - Country:US
Practice Address - Phone:203-790-0111
Practice Address - Fax:203-797-0822
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009782122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist