Provider Demographics
NPI:1144891722
Name:THAKKAR, SHREYA TUSHAR (DMD)
Entity type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:TUSHAR
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 ESCENA BLVD APT 2161
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4372
Mailing Address - Country:US
Mailing Address - Phone:847-769-1836
Mailing Address - Fax:
Practice Address - Street 1:1500 COMMONS CIR STE 100
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76226-2717
Practice Address - Country:US
Practice Address - Phone:469-307-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611801571223G0001X
TX402461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice