Provider Demographics
NPI:1841278694
Name:SHAH, HEMANTIKA (BDS)
Entity type:Individual
Prefix:DR
First Name:HEMANTIKA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SHEA DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1111
Mailing Address - Country:US
Mailing Address - Phone:201-265-7160
Mailing Address - Fax:201-265-7160
Practice Address - Street 1:747 MELROSE AVENUE
Practice Address - Street 2:C O MELROSE DENTAL OFFICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-585-5124
Practice Address - Fax:718-585-5124
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491814Medicaid