Provider Demographics
NPI:1124589098
Name:SHAH, LEENA (DMD)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LEENA
Other - Middle Name:
Other - Last Name:CHANDNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22106 US HIGHWAY 281 N STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7652
Mailing Address - Country:US
Mailing Address - Phone:210-714-5710
Mailing Address - Fax:
Practice Address - Street 1:22106 US HIGHWAY 281 N STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7652
Practice Address - Country:US
Practice Address - Phone:210-714-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386601223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program