Provider Demographics
NPI:1447811435
Name:GANJOOR, SHAHRIELA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAHRIELA
Middle Name:
Last Name:GANJOOR
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 1:14010 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-8641
Mailing Address - Country:US
Mailing Address - Phone:214-566-6097
Mailing Address - Fax:
Practice Address - Street 1:14010 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-8641
Practice Address - Country:US
Practice Address - Phone:214-566-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35207OtherGENERAL DENTIST