Provider Demographics
NPI:1720291735
Name:KRISH, SHAB R (DDS, MS, PA)
Entity type:Individual
Prefix:
First Name:SHAB
Middle Name:R
Last Name:KRISH
Suffix:
Gender:F
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4202
Mailing Address - Country:US
Mailing Address - Phone:972-538-3700
Mailing Address - Fax:972-538-3771
Practice Address - Street 1:1005 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4202
Practice Address - Country:US
Practice Address - Phone:972-538-3700
Practice Address - Fax:972-538-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140811223E0200X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223P0300XDental ProvidersDentistPeriodontics