# SAN TAN VALLEY ORAL FACIAL AND IMPLANT SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629546171
- **Authorized official:** NISHITH S SHAH D.M.D., M.D. (DOCTOR/OWNER)
- **Authorized official phone:** (480) 814-9500

## Contact information

- **Practice address:** 36327 N GANTZEL RD, SUITE 102, SAN TAN VALLEY, AZ 85140
- **Practice address phone:** (480) 814-9500
- **Practice address fax:** (520) 210-0442
- **Mailing address:** 2450 W RAY RD STE 1, CHANDLER, AZ 85224-3595
- **Mailing address phone:** (480) 814-9500
- **Mailing address fax:** (480) 814-9501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2018
- **Last updated:** 11/02/2018