Provider Demographics
NPI:1376702043
Name:BERARD, SHATONA LOUISE (DDS)
Entity Type:Individual
Prefix:
First Name:SHATONA
Middle Name:LOUISE
Last Name:BERARD
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 1:1459 WIRT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4916
Mailing Address - Country:US
Mailing Address - Phone:713-932-1045
Mailing Address - Fax:713-932-0989
Practice Address - Street 1:1459 WIRT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4916
Practice Address - Country:US
Practice Address - Phone:713-932-1045
Practice Address - Fax:713-932-0989
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice