Provider Demographics
NPI:1265706683
Name:SHAH, NAMRATA B
Entity type:Individual
Prefix:DR
First Name:NAMRATA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 FM 544 STE 200
Mailing Address - Street 2:CHAUCER HILL LANE
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4591
Mailing Address - Country:US
Mailing Address - Phone:682-433-3638
Mailing Address - Fax:
Practice Address - Street 1:1640 FM 544
Practice Address - Street 2:SUITE 200
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4591
Practice Address - Country:US
Practice Address - Phone:682-558-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice