Provider Demographics
NPI:1831522002
Name:SHAH-MODI, PRIYANKA (DDS)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:SHAH-MODI
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 1:173 TOVREA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2963
Mailing Address - Country:US
Mailing Address - Phone:281-824-4270
Mailing Address - Fax:
Practice Address - Street 1:173 TOVREA RD
Practice Address - Street 2:SUITE D
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2963
Practice Address - Country:US
Practice Address - Phone:281-824-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029585122300000X
TX31755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist