Provider Demographics
NPI:1720080658
Name:SHAH, SUNIL RASHMI (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:RASHMI
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NEAL
Other - Middle Name:RASHMI
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3807 SPICEWOOD SPRINGS ROAD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-454-2583
Mailing Address - Fax:512-454-0891
Practice Address - Street 1:3807 SPICEWOOD SPRINGS ROAD SUITE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-454-2583
Practice Address - Fax:512-454-0891
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2019-12-20
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
TX198091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice