Provider Demographics
NPI:1134596745
Name:SHIRGAVI, SHIVANI (DMD)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SHIRGAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FALLS BLVD UNIT A104
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8145
Mailing Address - Country:US
Mailing Address - Phone:302-290-4877
Mailing Address - Fax:
Practice Address - Street 1:70 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1811
Practice Address - Country:US
Practice Address - Phone:508-872-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist