Provider Demographics
NPI:1073373239
Name:THIRD DENTITION PLLC
Entity Type:Organization
Organization Name:THIRD DENTITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:614-779-5126
Mailing Address - Street 1:412 STAUNTON DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5471
Mailing Address - Country:US
Mailing Address - Phone:614-779-5126
Mailing Address - Fax:
Practice Address - Street 1:16009 FM 1325
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-2876
Practice Address - Country:US
Practice Address - Phone:614-779-5126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty