Provider Demographics
NPI:1245394139
Name:SHIH, JOLENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:SHIH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 NE 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4820
Mailing Address - Country:US
Mailing Address - Phone:425-223-4318
Mailing Address - Fax:
Practice Address - Street 1:4815 NE 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4820
Practice Address - Country:US
Practice Address - Phone:425-223-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist