Provider Demographics
NPI:1013132026
Name:ATASSI, SHANA (DDS)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:ATASSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 BLUFFSTONE CV
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7808
Mailing Address - Country:US
Mailing Address - Phone:512-345-4998
Mailing Address - Fax:512-345-4966
Practice Address - Street 1:8500 BLUFFSTONE CV
Practice Address - Street 2:SUITE B-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7808
Practice Address - Country:US
Practice Address - Phone:512-345-4998
Practice Address - Fax:512-345-4966
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice