Individual
KANCHI B SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 PENN AVE, WYOMISSING, PA 19610-2133
(610) 372-6693
Mailing address
981 KING WAY, BREINIGSVILLE, PA 18031-1483
(440) 864-1786
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS043323
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2018
Last updated
09/22/2021
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