Basic Information
| Provider Information | |||||||||
| NPI: | 1982970158 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARIANI SHAH LEGACY FAMILY DENTAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6655 POST RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430168214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143367643 | ||||||||
| FaxNumber: | 6143367653 | ||||||||
| Practice Location | |||||||||
| Address1: | 6655 POST RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430168214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143367643 | ||||||||
| FaxNumber: | 6143367653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2012 | ||||||||
| LastUpdateDate: | 04/01/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARIANI | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | DIANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER/DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 6143367643 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.D.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 21803 | OH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | 122300000X | 20142 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.