Provider Demographics
NPI:1972174472
Name:SHAH, KHUSHBU DIVYESHKUMAR (DDS)
Entity type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:DIVYESHKUMAR
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 1:12 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5525
Mailing Address - Country:US
Mailing Address - Phone:732-789-5507
Mailing Address - Fax:
Practice Address - Street 1:12 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5525
Practice Address - Country:US
Practice Address - Phone:732-789-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0432871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice