Provider Demographics
NPI:1164652954
Name:SHAH, SHIVANI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:C
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 N SHADOW MIST LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4570
Mailing Address - Country:US
Mailing Address - Phone:832-725-8621
Mailing Address - Fax:
Practice Address - Street 1:12805 CULLEN BLVD
Practice Address - Street 2:STE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3759
Practice Address - Country:US
Practice Address - Phone:713-264-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist