Provider Demographics
NPI:1275620502
Name:HUANG, SHANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19028 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2560
Mailing Address - Country:US
Mailing Address - Phone:408-996-8611
Mailing Address - Fax:408-996-8662
Practice Address - Street 1:19028 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2560
Practice Address - Country:US
Practice Address - Phone:408-996-8611
Practice Address - Fax:408-996-8662
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice