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General NPI Number Information
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NPI Number | 1710650338
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Entity Type | Individual
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Provider Name | LUNAN SHAO DDS
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 7905 INDIANAPOLIS BLVD
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City | HAMMOND
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State | IN
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Zip | 46324
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Country | US
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Telephone | 219-364-6388
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 S STATE ST UNIT 1708
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City | CHICAGO
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State | IL
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Zip | 60605-2231
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013650A
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License Number State | IN
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