Provider Demographics
NPI:1588141378
Name:BADHEKA, SHAUNAK ARUN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAUNAK
Middle Name:ARUN
Last Name:BADHEKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 TURNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-2337
Mailing Address - Country:US
Mailing Address - Phone:817-937-3251
Mailing Address - Fax:
Practice Address - Street 1:515 W LOOP 820 N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-1450
Practice Address - Country:US
Practice Address - Phone:817-937-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice