Provider Demographics
NPI:1780767822
Name:HAUSER, SHEENA DEVIKA SHUKLA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:DEVIKA SHUKLA
Last Name:HAUSER
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 1:625 E LANCASTER AVE
Mailing Address - Street 2:APT. B-101
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2014
Mailing Address - Country:US
Mailing Address - Phone:484-412-8698
Mailing Address - Fax:484-412-8698
Practice Address - Street 1:136 INDIAN TRAIL RD S # B
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9669
Practice Address - Country:US
Practice Address - Phone:704-821-7222
Practice Address - Fax:704-821-4310
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice