Provider Demographics
NPI:1023424579
Name:SHAH, RADHIKA (DDS)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SHAH
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 1:8610 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT 2305
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2600
Mailing Address - Country:US
Mailing Address - Phone:201-214-5137
Mailing Address - Fax:
Practice Address - Street 1:8610 SOUTHWESTERN BLVD
Practice Address - Street 2:APT 2305
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-2600
Practice Address - Country:US
Practice Address - Phone:201-214-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30231122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist