Individual provider Active NPI

Noopur P Shah

  • General Practice Dentistry
  • Denver, CO
National Provider Identifier
1073153110
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
00205212 Issued in CO
Practice address
705 E Colfax Ave #101
Denver, CO 80206
Phone
(303) 399-3001
NPI assigned
Jan 7, 2020
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019032460 IL
General Practice Dentistry 1223G0001X 00205212 CO Primary

Addresses

Primary practice location

705 E Colfax Ave #101
Denver, CO 80206

Mailing address

6220 Dayton CT
Denver, CO 80238-4416
Phone (650) 656-1505

Other practice location 1

2608 State St
East Saint Louis, IL 62205-2325
Phone (888) 988-4066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230724002174 CO Order and Referring Only - DentistPractitioner - Dentist 1052771987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00205212COMDGeneral Practice Dentistry
019032460ILMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1073153110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6220 DAYTON CT",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802384416",
            "telephone_number": "650-656-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E COLFAX AVE #101",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80206",
            "telephone_number": "303-399-3001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2608 State St",
            "address_purpose": "LOCATION",
            "city": "East Saint Louis",
            "state": "IL",
            "postal_code": "622052325",
            "country_code": "US",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "NOOPUR",
        "middle_name": "P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032460",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00205212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.