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General NPI Number Information
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NPI Number | 1932537487
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Entity Type | Organization
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Legal Business Name | SHEN DDS DENTAL CORP.
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Dates
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Enumeration Date | 10/20/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 20410 TOWN CENTER LN SUITE 190
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City | CUPERTINO
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State | CA
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Zip | 95014-3229
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Country | US
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Telephone | 408-713-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 20410 TOWN CENTER LN SUITE 190
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City | CUPERTINO
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State | CA
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Zip | 95014-3229
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Country | US
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Telephone | 408-713-0730
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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. JOHN SHEN
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Credential | D.D.S.
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Telephone | 510-918-3284
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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 | 59472
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License Number State | CA
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