Healthcare Provider Details

I. General information

NPI: 1144364019
Provider Name (Legal Business Name): DEAN SHAO EN DAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20932 BROOKHURST ST #202-203
HUNTINGTON BEACH CA
92646-6638
US

IV. Provider business mailing address

20932 BROOKHURST ST STE 202
HUNTINGTON BEACH CA
92646-6636
US

V. Phone/Fax

Practice location:
  • Phone: 323-717-5798
  • Fax:
Mailing address:
  • Phone: 714-968-5500
  • Fax: 714-968-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: