Provider Demographics
NPI:1831303379
Name:DANA, SHIDEH (RDH)
Entity Type:Individual
Prefix:
First Name:SHIDEH
Middle Name:
Last Name:DANA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4309
Mailing Address - Country:US
Mailing Address - Phone:281-485-7005
Mailing Address - Fax:281-485-7196
Practice Address - Street 1:3300 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4309
Practice Address - Country:US
Practice Address - Phone:281-485-7005
Practice Address - Fax:281-485-7196
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14153124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist