Provider Demographics
NPI:1154999027
Name:SHIVA, ALOK (DMD)
Entity type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:SHIVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S LAMAR BLVD APT 2437
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0174
Mailing Address - Country:US
Mailing Address - Phone:859-446-1894
Mailing Address - Fax:
Practice Address - Street 1:901 S MOPAC EXPY STE 470
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5776
Practice Address - Country:US
Practice Address - Phone:512-327-6947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice