Provider Demographics
NPI:1770238602
Name:SHAAN DENTAL PLLC
Entity Type:Organization
Organization Name:SHAAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOUVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-752-9936
Mailing Address - Street 1:5270 MARATHON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-752-9936
Mailing Address - Fax:
Practice Address - Street 1:5270 MARATHON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-752-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty