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General NPI Number Information
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NPI Number | 1861046872
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Entity Type | Individual
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Provider Name | DR. JOANNA SHEN
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 1150 S NELLIS BLVD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89104-5700
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Country | US
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Telephone | 702-505-9159
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Fax | 702-505-9159
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Provider Business Mailing Address
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Address Line | 8324 W CHARLESTON BLVD UNIT 1046
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City | LAS VEGAS
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State | NV
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Zip | 89117-9203
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Country | US
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Telephone | 626-203-7454
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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 | 7275
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License Number State | NV
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