Provider Demographics
NPI:1952925117
Name:SHAIKH, KOMAL (DMD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:SHAIKH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 BUFFALO PARK DR APT 1915
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-2220
Mailing Address - Country:US
Mailing Address - Phone:717-654-7393
Mailing Address - Fax:
Practice Address - Street 1:21212 KUYKENDAHL RD STE E
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2606
Practice Address - Country:US
Practice Address - Phone:281-350-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX37212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program