Provider Demographics
NPI:1154457836
Name:KU, SHIREEN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIREEN
Middle Name:K
Last Name:KU
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 1:115 LAUREL CREEK RD SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7000
Mailing Address - Country:US
Mailing Address - Phone:706-629-6100
Mailing Address - Fax:
Practice Address - Street 1:115 LAUREL CREEK RD SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7000
Practice Address - Country:US
Practice Address - Phone:706-629-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0110971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice