Healthcare Provider Details

I. General information

NPI: 1821438334
Provider Name (Legal Business Name): RAJIV B SHEKHADIYA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 CLEAR CREEK ROAD, # 213 FORT HOOD EXCHANGE SHOPPING CENTER
FORT HOOD TX
76544
US

IV. Provider business mailing address

3604 S W S YOUND DR 314
KILLEEN TX
76542
US

V. Phone/Fax

Practice location:
  • Phone: 254-285-2014
  • Fax: 254-285-2182
Mailing address:
  • Phone: 248-275-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: