Healthcare Provider Details

I. General information

NPI: 1033048400
Provider Name (Legal Business Name): XIAOYUE SHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 POINT FOSDICK DR STE 300
GIG HARBOR WA
98335-1846
US

IV. Provider business mailing address

1502 FAWCETT AVE APT 2518
TACOMA WA
98402-5521
US

V. Phone/Fax

Practice location:
  • Phone: 125-385-8802
  • Fax:
Mailing address:
  • Phone: 734-757-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70113061
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: