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General NPI Number Information
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NPI Number | 1558506592
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Entity Type | Individual
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Provider Name | NISHA SHAH DDS
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Gender | Female
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 9759 FOREST LN STE 450A
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City | DALLAS
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State | TX
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Zip | 75243-1302
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Country | US
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Telephone | 214-575-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 8245 PLUMBAGO WAY
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City | DALLAS
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State | TX
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Zip | 75252-8047
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Country | US
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Telephone | 615-715-3923
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000008936
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 26199
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License Number State | TX
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