Healthcare Provider Details

I. General information

NPI: 1124110861
Provider Name (Legal Business Name): SHEELA KUDCHADKER DDS MS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 BROADWAY STE 119
PEARLAND TX
77584-8094
US

IV. Provider business mailing address

9415 BROADWAY STE 119
PEARLAND TX
77584-8094
US

V. Phone/Fax

Practice location:
  • Phone: 281-436-8877
  • Fax: 281-854-2925
Mailing address:
  • Phone: 281-436-8877
  • Fax: 281-854-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: