Healthcare Provider Details

I. General information

NPI: 1578280459
Provider Name (Legal Business Name): SOVNA SHIVANI MISHRA BDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 FLOYD CURL DR
SAN ANTONIO TX
78229-3923
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-3342
  • Fax:
Mailing address:
  • Phone: 210-567-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL15370
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number40961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: