Samir Ashok Shah, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

22DI02384600 Issued in NJ

Practice address

3069 English Creek Ave
Ste 101
Egg Harbor Township, NJ 08234-9708

Phone

(609) 646-8443

Fax

(609) 646-2758

NPI assigned

Oct 1, 2008

Last updated

Mar 5, 2014By the provider in NPPES

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

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Jersey Periodontics PC

  • Periodontics
  • Egg Harbor Township, NJ
  • NPI 1245308444
  NPD (past)

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1235380817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3069 ENGLISH CREEK AVE",
            "address_2": "STE 101",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349708",
            "telephone_number": "609-646-8443",
            "fax_number": "609-646-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3069 ENGLISH CREEK AVE",
            "address_2": "STE 101",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349708",
            "telephone_number": "609-646-8443",
            "fax_number": "609-646-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SAMIR",
        "middle_name": "ASHOK",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-01",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "22DI02384600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry Sellars
• Karen Semet
• Keith Semler, DO
• Serenity Smile Designs, LLC
• Stephanie Sergeant, MS
• Taral Jobanputra Shah, M.D.
• Sanjay Shetty
• Erin Shober
• Tessa Lauren Shoemaker
• Shore Medical Center

• Periodontics in Egg Harbor Township, NJ
• Providers in Egg Harbor Township, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.