Khantil R Shah, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

04079 Issued in NH

Practice address

36 Bridge Way
Pascoag, RI 02859-3131

Phone

(401) 567-0800

Fax

(401) 568-0582

NPI assigned

Aug 8, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1194134601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 312",
            "city": "PASCOAG",
            "state": "RI",
            "postal_code": "028590312",
            "telephone_number": "401-567-0800",
            "fax_number": "401-567-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 BRIDGE WAY",
            "city": "PASCOAG",
            "state": "RI",
            "postal_code": "028593131",
            "telephone_number": "401-567-0800",
            "fax_number": "401-568-0582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KHANTIL",
        "middle_name": "R",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-08",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NH",
            "license": "04079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Maria Russo-Magno, MD
• Scarlett Santangelo, LCSW
• Lisa Ann Schiffmann, RN
• Karen Scott, LCDP
• Patricia Scuncio, PTA
• Sabrina Spaziano
• Kimberly Ann St.Andre, RN
• State of Rhode Island and Providence Plantations
• James Edward Sullivan, MA. PSY
• Amy E Sweet

• All providers in Pascoag, RI
• General Practice Dentistry in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.