Healthcare Provider Details

I. General information

NPI: 1518970011
Provider Name (Legal Business Name): TINA W SHIH DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 SHEPHERDS VINEYARD DR 2081 SHEPHERDS VINEYARD DR STE #102
APEX NC
27502
US

IV. Provider business mailing address

2081 SHEPHERDS VINEYARD DR STE #102
APEX NC
27502
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-9216
  • Fax: 919-362-8022
Mailing address:
  • Phone: 919-362-9216
  • Fax: 919-362-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6724
License Number StateNC

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. TINA W SHIH
Title or Position: DENTIST
Credential: DDS
Phone: 919-362-9216