Provider Demographics
NPI:1407006133
Name:SHU, MANG CHOU (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANG CHOU
Middle Name:
Last Name:SHU
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 1:1 FINANCIAL PLAZA 19 FLOOR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:860-247-5130
Mailing Address - Fax:860-524-9000
Practice Address - Street 1:1 FINANCIAL PLZ FL 19
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2608
Practice Address - Country:US
Practice Address - Phone:860-247-5130
Practice Address - Fax:860-524-9000
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0093001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice