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General NPI Number Information
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NPI Number | 1700464443
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Entity Type | Individual
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Provider Name | SHIYUAN MAO DMD
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Gender | Female
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 130 GRANITE ST STE C
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City | WESTERLY
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State | RI
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Zip | 02891-2461
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Country | US
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Telephone | 401-596-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 130 GRANITE ST STE C
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City | WESTERLY
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State | RI
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Zip | 02891-2461
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Country | US
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Telephone | 401-596-8720
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN2000475
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13933
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN03671
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License Number State | RI
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