Provider Demographics
NPI:1447415708
Name:SHRADER, CARRIE SIBLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:SIBLEY
Last Name:SHRADER
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 1:701 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-4205
Mailing Address - Country:US
Mailing Address - Phone:713-941-7555
Mailing Address - Fax:
Practice Address - Street 1:701 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-4205
Practice Address - Country:US
Practice Address - Phone:713-941-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist