Healthcare Provider Details

I. General information

NPI: 1891903043
Provider Name (Legal Business Name): DR. DENISE Y SHIH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 N MARIETTA AVE
MILWAUKEE WI
53211-3420
US

IV. Provider business mailing address

2853 N MARIETTA AVE
MILWAUKEE WI
53211-3420
US

V. Phone/Fax

Practice location:
  • Phone: 414-731-0758
  • Fax:
Mailing address:
  • Phone: 414-731-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD12293
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: