Provider Demographics
NPI:1174193213
Name:BISHAI, SHADY (DDS)
Entity Type:Individual
Prefix:
First Name:SHADY
Middle Name:
Last Name:BISHAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 MANSIONS BLFS APT 804
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4131
Mailing Address - Country:US
Mailing Address - Phone:619-278-9509
Mailing Address - Fax:
Practice Address - Street 1:9850C EMMETT F LOWRY EXPY STE C-103
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2122
Practice Address - Country:US
Practice Address - Phone:409-938-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND146171223G0001X
TX375401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice