Provider Demographics
NPI:1558510255
Name:CHANDIWAL, SHILPA JAIN (DDS, BDS)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:JAIN
Last Name:CHANDIWAL
Suffix:
Gender:F
Credentials:DDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CITADEL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7162
Mailing Address - Country:US
Mailing Address - Phone:713-955-2100
Mailing Address - Fax:713-904-1806
Practice Address - Street 1:167 CITADEL WAY STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-7162
Practice Address - Country:US
Practice Address - Phone:713-955-2100
Practice Address - Fax:713-904-1806
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25305122300000X, 1223S0112X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218348510Medicaid