Provider Demographics
NPI:1689016495
Name:SHAH, NAMRATA CHIRAG (DDS)
Entity type:Individual
Prefix:
First Name:NAMRATA
Middle Name:CHIRAG
Last Name:SHAH
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 1:1513 W HEBRON PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6466
Mailing Address - Country:US
Mailing Address - Phone:972-212-6225
Mailing Address - Fax:
Practice Address - Street 1:1513 W HEBRON PKWY STE 108
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6466
Practice Address - Country:US
Practice Address - Phone:972-212-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice