Provider Demographics
NPI:1134502057
Name:SHAD, VIKRAM (DMD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:SHAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 AUGUSTA DR STE 209
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2061
Mailing Address - Country:US
Mailing Address - Phone:713-623-0700
Mailing Address - Fax:
Practice Address - Street 1:1011 AUGUSTA DR STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2061
Practice Address - Country:US
Practice Address - Phone:713-623-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040545122300000X
NH04610122300000X
TX31360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist