Provider Demographics
NPI:1801182852
Name:SHAE OCHOA DDS, MS, PA
Entity Type:Organization
Organization Name:SHAE OCHOA DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-572-8543
Mailing Address - Street 1:2015 W FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2925
Mailing Address - Country:US
Mailing Address - Phone:903-572-8543
Mailing Address - Fax:888-317-8286
Practice Address - Street 1:2015 W FERGUSON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2925
Practice Address - Country:US
Practice Address - Phone:903-572-8543
Practice Address - Fax:888-317-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty