Provider Demographics
NPI:1336512094
Name:D.SHEN DENTAL CORP.
Entity Type:Organization
Organization Name:D.SHEN DENTAL CORP.
Other - Org Name:ALPINE DENTAL CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-938-1868
Mailing Address - Street 1:19028 STEVENS CREEK BLVD
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D.SHEN DENTAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53106305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization