Provider Demographics
NPI:1649647983
Name:SHEBAH DENTAL, PLLC
Entity type:Organization
Organization Name:SHEBAH DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWADAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWADARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-986-2797
Mailing Address - Street 1:530 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5007
Mailing Address - Country:US
Mailing Address - Phone:210-986-2797
Mailing Address - Fax:210-247-9383
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5007
Practice Address - Country:US
Practice Address - Phone:210-986-2797
Practice Address - Fax:210-247-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty