Provider Demographics
NPI:1114478427
Name:SHAH DENTAL
Entity Type:Organization
Organization Name:SHAH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-643-8429
Mailing Address - Street 1:16918 BLUE MIST CIR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4816
Mailing Address - Country:US
Mailing Address - Phone:832-643-8429
Mailing Address - Fax:
Practice Address - Street 1:5631 TELEPHONE RD
Practice Address - Street 2:#A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4485
Practice Address - Country:US
Practice Address - Phone:832-643-8429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty