Provider Demographics
NPI:1992779706
Name:SHAH, DIPIKA T (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:DIPIKA
Middle Name:T
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N BEERS ST
Mailing Address - Street 2:SUITE 2 F
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1517
Mailing Address - Country:US
Mailing Address - Phone:732-264-8180
Mailing Address - Fax:732-264-5193
Practice Address - Street 1:723 N BEERS ST
Practice Address - Street 2:SUITE 2 F
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1517
Practice Address - Country:US
Practice Address - Phone:732-264-8180
Practice Address - Fax:732-264-5193
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ195351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice