Provider Demographics
NPI:1548468820
Name:SHAHWAN, GABRIEL (DDS)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:SHAHWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 PAINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5063
Mailing Address - Country:US
Mailing Address - Phone:817-449-2203
Mailing Address - Fax:214-599-8897
Practice Address - Street 1:4800 S HULEN ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1400
Practice Address - Country:US
Practice Address - Phone:817-877-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice