Provider Demographics
NPI:1386862514
Name:BIRTH, SHEILA T (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:T
Last Name:BIRTH
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 BASSWOOD BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4499
Mailing Address - Country:US
Mailing Address - Phone:817-348-0910
Mailing Address - Fax:817-348-0422
Practice Address - Street 1:5407 BASSWOOD BLVD STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4499
Practice Address - Country:US
Practice Address - Phone:817-348-0910
Practice Address - Fax:817-348-0422
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX079796211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091086103Medicaid
TX172836201Medicaid