Provider Demographics
NPI:1407979776
Name:SHIBA, NANCY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:SHIBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N JACKSON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1914
Mailing Address - Country:US
Mailing Address - Phone:408-929-8991
Mailing Address - Fax:408-929-8997
Practice Address - Street 1:125 N JACKSON AVE.
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1914
Practice Address - Country:US
Practice Address - Phone:408-929-8991
Practice Address - Fax:408-929-8997
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice