Provider Demographics
NPI:1184939092
Name:SHAH, SUHANI K (DDS)
Entity type:Individual
Prefix:
First Name:SUHANI
Middle Name:K
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 1:34173 GANNON TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1943
Mailing Address - Country:US
Mailing Address - Phone:650-450-0677
Mailing Address - Fax:
Practice Address - Street 1:19682 HESPERIAN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:650-450-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595911223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes1223G0001XDental ProvidersDentistGeneral Practice