Provider Demographics
NPI:1831463884
Name:SHANDRA CUSHINGBERRY, DDS, PA
Entity Type:Organization
Organization Name:SHANDRA CUSHINGBERRY, DDS, PA
Other - Org Name:SIMPLY SMILES FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHINGBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-551-9400
Mailing Address - Street 1:10350 S POST OAK RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3313
Mailing Address - Country:US
Mailing Address - Phone:713-551-9400
Mailing Address - Fax:713-551-9405
Practice Address - Street 1:10350 S POST OAK RD
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3313
Practice Address - Country:US
Practice Address - Phone:713-551-9400
Practice Address - Fax:713-551-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19439261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135072011Medicaid
TX336290OtherDENTAQUEST