Healthcare Provider Details

I. General information

NPI: 1245249820
Provider Name (Legal Business Name): XUE YU SHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LINDEN STREET
WORCESTER MA
01609
US

IV. Provider business mailing address

9 LINDEN STREET
WORCESTER MA
01609
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-0008
  • Fax: 508-770-0603
Mailing address:
  • Phone: 508-755-0008
  • Fax: 508-770-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21007
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: