Provider Demographics
NPI:1306367180
Name:SHWETA TAWDE DENTAL PLLC
Entity Type:Organization
Organization Name:SHWETA TAWDE DENTAL PLLC
Other - Org Name:BRIGHT DENTAL SEALY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHWETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAWDE
Authorized Official - Suffix:
Authorized Official - Credentials:MSD
Authorized Official - Phone:713-598-9073
Mailing Address - Street 1:22522 SAIL HARBOUR CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8061
Mailing Address - Country:US
Mailing Address - Phone:713-598-9073
Mailing Address - Fax:
Practice Address - Street 1:2308 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-4223
Practice Address - Country:US
Practice Address - Phone:713-598-9073
Practice Address - Fax:713-598-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29256261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1699109405Medicaid
TX1053452862Medicaid