Provider Demographics
NPI:1649871484
Name:KUMAR, SHASHI PRABHA (DDS)
Entity type:Individual
Prefix:
First Name:SHASHI
Middle Name:PRABHA
Last Name:KUMAR
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 1:2510 S 31ST ST APT 3309
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7134
Mailing Address - Country:US
Mailing Address - Phone:424-389-6765
Mailing Address - Fax:
Practice Address - Street 1:301 CONSTITUTION DR STE 300
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2658
Practice Address - Country:US
Practice Address - Phone:083-377-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice