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General NPI Number Information
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NPI Number | 1811437684
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Entity Type | Organization
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Legal Business Name | CHARMDENTAL
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 3403 LOUETTA RD SUITE B
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City | SPRING
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State | TX
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Zip | 77388-4868
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Country | US
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Telephone | 201-214-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 BROWNWAY ST APT 2111
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City | HOUSTON
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State | TX
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Zip | 77056-4932
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Country | US
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Telephone | 201-214-5137
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | RADHIKA SHAH
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Credential | DDS
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Telephone | 201-214-5137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30231
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License Number State | TX
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