Provider Demographics
NPI:1629414941
Name:SHEBAH DENTAL PLLC
Entity Type:Organization
Organization Name:SHEBAH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWADAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLUWADARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-954-6377
Mailing Address - Street 1:9160 FM 78
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2039
Mailing Address - Country:US
Mailing Address - Phone:210-998-3013
Mailing Address - Fax:210-579-6484
Practice Address - Street 1:9160 FM 78
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2039
Practice Address - Country:US
Practice Address - Phone:210-998-3013
Practice Address - Fax:210-579-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty