Shady Hollow Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SHADY HOLLOW DENTAL PLLC

Doing business as

Oak Park Dental

Practice address

9901 Brodie LN Ste 130
Austin, TX 78748-5889

Phone

(281) 328-4900

Fax

(877) 291-5828

NPI assigned

Jan 6, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Geetika Rastogi

Title

Owner

Phone

(832) 369-6941

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Oak Park Dental Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1770171647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 N SAM HOUSTON PKWY E STE 430",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770323418",
            "telephone_number": "832-369-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 BRODIE LN STE 130",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787485889",
            "telephone_number": "281-328-4900",
            "fax_number": "877-291-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY HOLLOW DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-06",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "RASTOGI",
        "authorized_official_first_name": "GEETIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-369-6941",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295967164",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "manager.cfd@smilepoint.us",
            "affiliation": "N",
            "address_1": "9901 Brodie Ln Ste 130",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787485889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Oak Park Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oak Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vicki Shackelford, LPC
• Caroline M Shackett, PHD
• Daniel Albert Shaddock, D.C.
• Ashkan Shademan, M.D.
• Leah Shadwick, L.AC.
• Zane Aaron Shaeffer, M.D.
• Jennifer Shafer, MD
• Karen Eleanor Boyd Shafer, LPC
• Kathleen M Shafer, O.D.
• Haley Shaffer

• General Practice Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.