Healthcare Provider Details

I. General information

NPI: 1114657376
Provider Name (Legal Business Name): CATHERINE SHAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2645
US

IV. Provider business mailing address

6020 DELILAH RD APT 2205
EGG HARBOR TOWNSHIP NJ
08234-5578
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1065
  • Fax:
Mailing address:
  • Phone: 267-475-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043711
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02913200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: