Basic Information
| Provider Information | |||||||||
| NPI: | 1083229124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | RAHUL | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702528896 | ||||||||
| FaxNumber: | 9702403095 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702528896 | ||||||||
| FaxNumber: | 9702403095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2020 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN.00204259 | CO | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | DEN.00204259 | 01 | CO | COLORADO STATE | OTHER |