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General NPI Number Information
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NPI Number | 1831463884
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Entity Type | Organization
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Legal Business Name | SHANDRA CUSHINGBERRY, DDS, PA
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 10350 S POST OAK RD SUITE H
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City | HOUSTON
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State | TX
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Zip | 77035-3313
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Country | US
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Telephone | 713-551-9400
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Fax | 713-551-9405
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Provider Business Mailing Address
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Address Line | 10350 S POST OAK RD SUITE H
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City | HOUSTON
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State | TX
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Zip | 77035-3313
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Country | US
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Telephone | 713-551-9400
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Fax | 713-551-9405
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SHANDRA CUSHINGBERRY
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Credential | DDS
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Telephone | 713-551-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19439
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License Number State | TX
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