MEDICARE: SHAAN DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1770238602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAAN DENTAL PLLC

Provider Business Mailing Address
First Line	:	5270 MARATHON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-752-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	5270 MARATHON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-752-9936
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SOUVIK SARKAR
Credential	:	DDS
Telephone Number	:	817-752-9936

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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