Provider Demographics
NPI:1952762254
Name:SHAH & VELILLA DDS PC
Entity type:Organization
Organization Name:SHAH & VELILLA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-427-9003
Mailing Address - Street 1:39915 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2154
Mailing Address - Country:US
Mailing Address - Phone:248-427-9003
Mailing Address - Fax:248-427-9011
Practice Address - Street 1:39915 GRAND RIVER AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2154
Practice Address - Country:US
Practice Address - Phone:248-427-9003
Practice Address - Fax:248-427-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010160901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty