Provider Demographics
NPI:1962411173
Name:SHAH, NAYANESH K (DDS)
Entity type:Individual
Prefix:DR
First Name:NAYANESH
Middle Name:K
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 1:1081 PARSIPPANY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1291
Mailing Address - Country:US
Mailing Address - Phone:973-299-6161
Mailing Address - Fax:973-299-1800
Practice Address - Street 1:1081 PARSIPPANY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1291
Practice Address - Country:US
Practice Address - Phone:973-299-6161
Practice Address - Fax:973-299-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ162721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1305506Medicaid