MEDICARE: RADHIKA SHAH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30231	TX
2	1223G0001X	General Practice Dentistry	30231	TX

General Provider Information

NPI Number	:	1023424579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADHIKA SHAH DDS

Provider Business Mailing Address
First Line	:	8610 SOUTHWESTERN BLVD
Second Line	:	APT 2305
City	:	DALLAS
State	:	TX
Zip	:	75206-2600
Country	:	US
Telephone Number	:	201-214-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 SOUTHWESTERN BLVD
Second Line	:	APT 2305
City	:	DALLAS
State	:	TX
Zip	:	75206-2600
Country	:	US
Telephone Number	:	201-214-5136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2014
Last Update Date	:	09/29/2022

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