Provider Demographics
NPI:1912088527
Name:DENGLE, SHASHANK KRISHNAJI (MD)
Entity type:Individual
Prefix:MR
First Name:SHASHANK
Middle Name:KRISHNAJI
Last Name:DENGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 ED HALL DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1861
Mailing Address - Country:US
Mailing Address - Phone:972-932-4800
Mailing Address - Fax:972-932-7959
Practice Address - Street 1:874 ED HALL DR
Practice Address - Street 2:SUITE 111
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1861
Practice Address - Country:US
Practice Address - Phone:972-932-4800
Practice Address - Fax:972-932-7959
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1686207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098049201Medicaid
TX098049201Medicaid
TXB64236Medicare UPIN