Provider Demographics
NPI:1821721275
Name:SHAHID DENTAL GROUP GLADEWATER, PLLC
Entity Type:Organization
Organization Name:SHAHID DENTAL GROUP GLADEWATER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSNAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-305-8750
Mailing Address - Street 1:244 KATHRYNS CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-6709
Mailing Address - Country:US
Mailing Address - Phone:903-305-8750
Mailing Address - Fax:
Practice Address - Street 1:406 W UPSHUR AVE
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-2124
Practice Address - Country:US
Practice Address - Phone:903-845-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty