Provider Demographics
NPI:1306399274
Name:OYSTER CREEK DENTISTRY
Entity type:Organization
Organization Name:OYSTER CREEK DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-725-8621
Mailing Address - Street 1:9402 HIGHWAY 6
Mailing Address - Street 2:STE 500
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4885
Mailing Address - Country:US
Mailing Address - Phone:281-915-5429
Mailing Address - Fax:281-972-9835
Practice Address - Street 1:9402 HIGHWAY 6
Practice Address - Street 2:STE 500
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4885
Practice Address - Country:US
Practice Address - Phone:281-915-5429
Practice Address - Fax:281-972-9835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty