Healthcare Provider Details

I. General information

NPI: 1366894453
Provider Name (Legal Business Name): KARL S SHAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 09/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 SW 10TH AVE STE 704
PORTLAND OR
97205
US

IV. Provider business mailing address

511 SW 10TH AVE STE 704
PORTLAND OR
97205
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2883
  • Fax: 503-226-5627
Mailing address:
  • Phone: 503-227-2883
  • Fax: 503-226-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10467
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: