Provider Demographics
NPI:1588393094
Name:SHAY, HEIDI ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ANN
Last Name:SHAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14633 WOODSON PARK DR APT 511
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-4509
Mailing Address - Country:US
Mailing Address - Phone:361-652-8019
Mailing Address - Fax:
Practice Address - Street 1:7315 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3130
Practice Address - Country:US
Practice Address - Phone:361-652-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385111223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice