Provider Demographics
NPI:1659891398
Name:SHAH, ESHA (DDS)
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:
Last Name:SHAH
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 1:19434 GRAN ROBLE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3332
Mailing Address - Country:US
Mailing Address - Phone:213-440-2132
Mailing Address - Fax:
Practice Address - Street 1:23522 WILDERNESS OAK STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2409
Practice Address - Country:US
Practice Address - Phone:210-757-3199
Practice Address - Fax:210-757-3192
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice