Provider Demographics
NPI:1053674424
Name:SHAN, DEBBIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:
Last Name:SHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S EOLA DR
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2888
Mailing Address - Country:US
Mailing Address - Phone:516-376-8471
Mailing Address - Fax:
Practice Address - Street 1:5345 3RD ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3928
Practice Address - Country:US
Practice Address - Phone:813-782-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice