Provider Demographics
NPI:1659353324
Name:SHAH, RUPEN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPEN
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 DREWS MANOR CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2274
Mailing Address - Country:US
Mailing Address - Phone:951-818-4228
Mailing Address - Fax:
Practice Address - Street 1:11767 KATY FWY STE 960
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1729
Practice Address - Country:US
Practice Address - Phone:281-558-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353601223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty