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General NPI Number Information
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NPI Number | 1235748120
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Entity Type | Organization
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Legal Business Name | SHANG DMD DENTAL CORPORATION
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 21222 BEACH BLVD
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5411
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Country | US
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Telephone | 949-381-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 13208 MYFORD RD APT 341
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City | TUSTIN
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State | CA
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Zip | 92782-9113
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Country | US
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Telephone | 909-570-7820
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WYNN SHANG
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Credential | DMD
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Telephone | 909-570-7820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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