Basic Information
| Provider Information | |||||||||
| NPI: | 1164652954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SHIVANI | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4310 N SHADOW MIST LN | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327258621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12805 CULLEN BLVD | ||||||||
| Address2: | STE E | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770473759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132647333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 02/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 24766 | TX | Y | Dental Providers | Dentist |
No ID Information.