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Organization
SAN TAN VALLEY ORAL FACIAL AND IMPLANT SURGERY PLLC
Active
Organization
SAN TAN VALLEY ORAL FACIAL AND IMPLANT SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NISHITH S SHAH D.M.D., M.D. (DOCTOR/OWNER)
(480) 814-9500
Entity
Organization
Contact information
Practice address
36327 N GANTZEL RD, SUITE 102, SAN TAN VALLEY, AZ 85140
(480) 814-9500
(520) 210-0442
Mailing address
2450 W RAY RD STE 1, CHANDLER, AZ 85224-3595
(480) 814-9500
(480) 814-9501
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
11/02/2018
Last updated
11/02/2018
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