Provider Demographics
NPI:1295084820
Name:SHILPA CHANDIWAL DDS, PLLC
Entity type:Organization
Organization Name:SHILPA CHANDIWAL DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:JAIN
Authorized Official - Last Name:CHANDIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-955-2100
Mailing Address - Street 1:167 CITADEL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7162
Mailing Address - Country:US
Mailing Address - Phone:713-955-2100
Mailing Address - Fax:713-904-1806
Practice Address - Street 1:167 CITADEL WAY STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-7162
Practice Address - Country:US
Practice Address - Phone:713-955-2100
Practice Address - Fax:713-904-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218348510Medicaid