Provider Demographics
NPI:1033841713
Name:SHAH, TAKSH NIPOON (DMD)
Entity type:Individual
Prefix:
First Name:TAKSH
Middle Name:NIPOON
Last Name:SHAH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HADDONFIELD RD APT 10203
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1242
Mailing Address - Country:US
Mailing Address - Phone:201-724-7014
Mailing Address - Fax:
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:856-583-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO436051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice