Provider Demographics
NPI:1043733942
Name:SHYU, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SHYU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 FROSTPROOF ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6720
Mailing Address - Country:US
Mailing Address - Phone:408-504-1229
Mailing Address - Fax:
Practice Address - Street 1:545 MARKS ST STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6501
Practice Address - Country:US
Practice Address - Phone:702-425-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist