Individual
MR. KRIMISH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13146 CORTEZ BLVD FL 34613, BROOKSVILLE, FL 34613-4858
(352) 596-8199
Mailing address
19697 LONG LAKE RANCH BLVD, LUTZ, FL 33558-5494
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH2054
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NOT REQUIRED
—
Enumeration date
12/07/2020
Last updated
12/07/2020
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