Provider Demographics
NPI:1558109124
Name:GAKHAR, SHREYA
Entity type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:
Last Name:GAKHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504441 GREY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:WIARTON
Mailing Address - State:ON
Mailing Address - Zip Code:N0H2T0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5350 INDEPENDENCE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4656
Practice Address - Country:US
Practice Address - Phone:469-238-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX409521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program