Provider Demographics
NPI:1851659163
Name:SHAH, MARLINA M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARLINA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARLINA
Other - Middle Name:M
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:121 E 6TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2595
Mailing Address - Country:US
Mailing Address - Phone:740-524-9372
Mailing Address - Fax:
Practice Address - Street 1:121 E 6TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2595
Practice Address - Country:US
Practice Address - Phone:740-524-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023693122300000X
OH30-0236931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080535Medicaid