Healthcare Provider Details

I. General information

NPI: 1134285877
Provider Name (Legal Business Name): MARIA SHEU KIDWELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. MARIA MIAO-YIN SHEU

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 N FINE AVE, STE. 102
FRESNO CA
93727
US

IV. Provider business mailing address

1865 HERNDON AVE, STE. K-245
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-840-1082
  • Fax: 909-558-0106
Mailing address:
  • Phone: 909-558-4611
  • Fax: 909-558-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number41787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: