Healthcare Provider Details

I. General information

NPI: 1972235851
Provider Name (Legal Business Name): CHAO SHEN DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 117TH AVE STE 110
VANCOUVER WA
98683-5297
US

IV. Provider business mailing address

601 SE 117TH AVE STE 110
VANCOUVER WA
98683-5297
US

V. Phone/Fax

Practice location:
  • Phone: 360-334-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: CHAO SHEN
Title or Position: MEMBER
Credential: DMD
Phone: 503-560-9745