Provider Demographics
NPI:1134285877
Name:KIDWELL, MARIA SHEU (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SHEU
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:MIAO-YIN
Other - Last Name:SHEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1865 HERNDON AVE, STE. K-245
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611
Mailing Address - Country:US
Mailing Address - Phone:909-558-4611
Mailing Address - Fax:909-558-0106
Practice Address - Street 1:1705 N FINE AVE, STE. 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727
Practice Address - Country:US
Practice Address - Phone:559-840-1082
Practice Address - Fax:909-558-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41787OtherDENTAL LICENSE