Provider Demographics
NPI:1003590662
Name:SHAH, HARDIK JAYESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARDIK
Middle Name:JAYESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 PLUCHEA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-5721
Mailing Address - Country:US
Mailing Address - Phone:909-751-5291
Mailing Address - Fax:
Practice Address - Street 1:9813 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4113
Practice Address - Country:US
Practice Address - Phone:512-593-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist