Basic Information
| Provider Information | |||||||||
| NPI: | 1053472613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | DEVANG | ||||||||
| MiddleName: | VINAYKANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5455 MCGINNIS VILLAGE PLACE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300052648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707511500 | ||||||||
| FaxNumber: | 7707511508 | ||||||||
| Practice Location | |||||||||
| Address1: | 5455 MCGINNIS VILLAGE PLACE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300052648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707511500 | ||||||||
| FaxNumber: | 7707511508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 0401411757 | VA | N | Dental Providers | Dentist | 122300000X | DN013630 | GA | N | Dental Providers | Dentist | 1223G0001X | DS036872 | PA | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN013630 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.