=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164700266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIANGYUN SHENG D.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2011
-----------------------------------------------------
Last Update Date | 08/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 SAMOSET ST SUITE 5
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-4815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-4456
-----------------------------------------------------
Fax | 508-927-2055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 NORTHAMPTON ST APT 2003
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02118-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-279-3719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 03853
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------