Healthcare Provider Details

I. General information

NPI: 1982875753
Provider Name (Legal Business Name): SHIEH DENTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45A PLEASANT ST
MALDEN MA
02148-4904
US

IV. Provider business mailing address

45A PLEASANT ST
MALDEN MA
02148-4904
US

V. Phone/Fax

Practice location:
  • Phone: 781-388-2224
  • Fax: 781-388-2226
Mailing address:
  • Phone: 781-388-2224
  • Fax: 781-388-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. SHIHCHI SHIEH
Title or Position: DENTIST
Credential: DMD
Phone: 781-388-2224