Provider Demographics
NPI:1265682363
Name:SHEN, IRVING JEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:JEN
Last Name:SHEN
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 1:105 PINE BLUFF RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-749-9180
Mailing Address - Fax:
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7160
Practice Address - Country:US
Practice Address - Phone:410-749-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD6558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist