Provider Demographics
NPI:1285774778
Name:CUSHINGBERRY-RAND, SHANDRA DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANDRA
Middle Name:DENISE
Last Name:CUSHINGBERRY-RAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 S POST OAK RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3313
Mailing Address - Country:US
Mailing Address - Phone:713-551-9400
Mailing Address - Fax:713-551-9405
Practice Address - Street 1:10350 S POST OAK RD
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3313
Practice Address - Country:US
Practice Address - Phone:713-551-9400
Practice Address - Fax:713-551-9405
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135072011Medicaid