Provider Demographics
NPI:1912321860
Name:SHAIK, MUJIBUNNISA
Entity Type:Individual
Prefix:
First Name:MUJIBUNNISA
Middle Name:
Last Name:SHAIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 COACH HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3738
Mailing Address - Country:US
Mailing Address - Phone:469-837-0853
Mailing Address - Fax:
Practice Address - Street 1:4908 HIBERNIA DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7553
Practice Address - Country:US
Practice Address - Phone:720-288-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist