Healthcare Provider Details

I. General information

NPI: 1659353324
Provider Name (Legal Business Name): RUPEN K SHAH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11767 KATY FWY STE 960
HOUSTON TX
77079-1729
US

IV. Provider business mailing address

2919 DREWS MANOR CT
KATY TX
77494-2274
US

V. Phone/Fax

Practice location:
  • Phone: 281-558-1144
  • Fax:
Mailing address:
  • Phone: 951-818-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number35360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: