Individual
RAVI GAURANG SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
171 LAKE AVE, COLONIA, NJ 07067-1354
(732) 318-9820
Mailing address
171 LAKE AVE, COLONIA, NJ 07067-1354
(732) 318-9820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02759500
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2019
Last updated
03/22/2021
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