Provider Demographics
NPI:1497884084
Name:SHAH, SARITA (DDS)
Entity type:Individual
Prefix:DR
First Name:SARITA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARITA
Other - Middle Name:SHAH
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:442 SOUTHRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4299
Mailing Address - Country:US
Mailing Address - Phone:214-205-0548
Mailing Address - Fax:
Practice Address - Street 1:442 SOUTHRIDGE WAY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4299
Practice Address - Country:US
Practice Address - Phone:214-205-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164681201Medicaid
TX20840OtherCDC CHIP
TX20840OtherCDC CHIP