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General NPI Number Information
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NPI Number | 1164005310
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Entity Type | Organization
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Legal Business Name | SHEN SMILES
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 565 W PENN PIKE STE 1
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City | TAMAQUA
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State | PA
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Zip | 18252-5673
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Country | US
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Telephone | 570-225-7498
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Fax | 570-225-7495
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Provider Business Mailing Address
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Address Line | 565 W PENN PIKE STE 1
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City | TAMAQUA
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State | PA
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Zip | 18252-5673
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Country | US
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Telephone | 570-225-7498
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Fax | 570-225-7495
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LINDA SHEN
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Credential | DDS
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Telephone | 570-956-9962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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