Provider Demographics
NPI:1508172057
Name:HANIS, SHAD B (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:B
Last Name:HANIS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 COMMERCIAL CENTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6406
Mailing Address - Country:US
Mailing Address - Phone:281-693-1333
Mailing Address - Fax:281-693-2207
Practice Address - Street 1:2830 COMMERCIAL CENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6406
Practice Address - Country:US
Practice Address - Phone:281-693-1333
Practice Address - Fax:281-693-2207
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics