Gautam Shirodkar, BDS MS

Primary specialty

DentistTaxonomy code 122300000X

License

ETN810 Issued in TX

Practice address

7703 Floyd Curl Dr # 7892
San Antonio, TX 78229-3901

Phone

(210) 567-3381

Fax

(210) 567-3389

NPI assigned

May 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Uthscsa, Dental School

  • Preferred Provider Organization
  • San Antonio, TX
  • NPI 1639508799
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1447825567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR. MAIL CODE 7892",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293900",
            "telephone_number": "210-567-3381",
            "fax_number": "210-567-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR # 7892",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293901",
            "telephone_number": "210-567-3381",
            "fax_number": "210-567-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRODKAR",
        "first_name": "GAUTAM",
        "name_prefix": "Dr.",
        "credential": "BDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-06-15",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "ETN810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorraine Shirley-Wenzel, M.D.
• Emrie T Shirley, RBT
• Jack Shirley
• Jared Quincy Shirley, D.C.
• Kobe Shirley
• Katie Shiroma
• Valerie Fisher Shiu, MD
• Shiva Izaddoust D.D.S. P.a.
• Shivam Medical Group, PA
• Bhargavi Shivaprasad

• Dentist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.