Individual provider Active NPI

Nisha Shah, DDS

  • Dentist
  • Dallas, TX
National Provider Identifier
1558506592
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
26199 Issued in TX
Practice address
9759 Forest LN Ste 450a
Dallas, TX 75243-1302
Phone
(214) 575-3900
NPI assigned
Dec 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS0000008936 TN
Dentist 122300000X 26199 TX Primary

Addresses

Primary practice location

9759 Forest LN Ste 450a
Dallas, TX 75243-1302

Mailing address

8245 Plumbago Way
Dallas, TX 75252-8047
Phone (615) 715-3923

Other practice location 1

655 W Illinois Ave
Dallas, TX 75224-1814
Phone (214) 948-7621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150114000708 TX Order and Referring Only - DentistPractitioner - Dentist 6103140579

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS0000008936TNMDDentist
26199TXMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1558506592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8245 PLUMBAGO WAY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752528047",
            "telephone_number": "615-715-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9759 FOREST LN STE 450A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752431302",
            "telephone_number": "214-575-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "655 W Illinois Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752241814",
            "country_code": "US",
            "telephone_number": "214-948-7621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "NISHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-04",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS0000008936",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "26199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.