Provider Demographics
NPI:1427536853
Name:SHRESTHA, SHREE SHANKER
Entity type:Individual
Prefix:DR
First Name:SHREE
Middle Name:SHANKER
Last Name:SHRESTHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 OGLETHORPE LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7909
Mailing Address - Country:US
Mailing Address - Phone:832-677-8307
Mailing Address - Fax:
Practice Address - Street 1:2950 SOUTHMOST BOULEVARD #103
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4787
Practice Address - Country:US
Practice Address - Phone:956-413-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty