Provider Demographics
NPI:1962696914
Name:SHAH, JYOTI R (DDS)
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HANCOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENDELL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-246-8181
Mailing Address - Fax:732-246-4244
Practice Address - Street 1:646 HERMANN ROAD
Practice Address - Street 2:
Practice Address - City:NO BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2833
Practice Address - Country:US
Practice Address - Phone:732-246-8181
Practice Address - Fax:732-246-4244
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10182451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice