Provider Demographics
NPI:1104044791
Name:SHI, JOHN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:SHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4554
Mailing Address - Country:US
Mailing Address - Phone:212-925-7066
Mailing Address - Fax:212-925-7066
Practice Address - Street 1:139 CENTRE ST STE 306
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4554
Practice Address - Country:US
Practice Address - Phone:212-925-7066
Practice Address - Fax:212-925-7066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist