Healthcare Provider Details

I. General information

NPI: 1992859409
Provider Name (Legal Business Name): DAVID SHEN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALFRED NOBEL DRIVE #125
HERCULES CA
94547
US

IV. Provider business mailing address

883 SNEATH LANE #130
SAN BRUNO CA
94066
US

V. Phone/Fax

Practice location:
  • Phone: 510-741-8808
  • Fax: 510-741-8885
Mailing address:
  • Phone: 650-589-4563
  • Fax: 650-589-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID T SHEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: DMD
Phone: 650-589-4563