Provider Demographics
NPI:1396097044
Name:SHAO, JILLY (DDS)
Entity type:Individual
Prefix:
First Name:JILLY
Middle Name:
Last Name:SHAO
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 1:18135 BELTRESS CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2994
Mailing Address - Country:US
Mailing Address - Phone:832-641-1879
Mailing Address - Fax:
Practice Address - Street 1:2320 B F TERRY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6379
Practice Address - Country:US
Practice Address - Phone:329-688-6508
Practice Address - Fax:281-762-7359
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist