Provider Demographics
NPI:1902898570
Name:SHAH, VIJAYKUMAR C (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIJAYKUMAR
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:C
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:68 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3621
Mailing Address - Country:US
Mailing Address - Phone:914-478-1467
Mailing Address - Fax:
Practice Address - Street 1:3250 THIRD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6743
Practice Address - Country:US
Practice Address - Phone:718-842-6960
Practice Address - Fax:718-842-6960
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice