Healthcare Provider Details

I. General information

NPI: 1295881597
Provider Name (Legal Business Name): SANDRA SHIH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD SUITE 209
WHITE MARSH MD
21162
US

IV. Provider business mailing address

5430 CAMPBELL BLVD SUITE 209
WHITE MARSH MD
21162-5500
US

V. Phone/Fax

Practice location:
  • Phone: 443-725-4185
  • Fax: 443-725-4187
Mailing address:
  • Phone: 443-725-4185
  • Fax: 443-725-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13125
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: