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General NPI Number Information
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NPI Number | 1407006133
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Entity Type | Individual
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Provider Name | MANG CHOU SHU D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 1 FINANCIAL PLZ FL 19
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City | HARTFORD
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State | CT
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Zip | 06103-2608
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Country | US
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Telephone | 860-247-5130
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Fax | 860-524-9000
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Provider Business Mailing Address
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Address Line | 1 FINANCIAL PLAZA 19 FLOOR
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City | HARTFORD
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State | CT
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Zip | 06103
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Country | US
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Telephone | 860-247-5130
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Fax | 860-524-9000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009300
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License Number State | CT
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