Provider Demographics
NPI:1073835195
Name:KEN M. SHOU DDS INC
Entity Type:Organization
Organization Name:KEN M. SHOU DDS INC
Other - Org Name:SURPRISE LAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-922-5401
Mailing Address - Street 1:900 MERIDIAN E STE 27
Mailing Address - Street 2:STE.27
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-7003
Mailing Address - Country:US
Mailing Address - Phone:253-922-5401
Mailing Address - Fax:253-926-8048
Practice Address - Street 1:900 MERIDIAN E STE 27
Practice Address - Street 2:STE.27
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-7003
Practice Address - Country:US
Practice Address - Phone:253-922-5401
Practice Address - Fax:253-926-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty