Provider Demographics
NPI:1437107893
Name:MAN, SHIRLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:MAN
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 1:3600 DE SOUZA PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5110
Mailing Address - Country:US
Mailing Address - Phone:661-834-3600
Mailing Address - Fax:661-834-3605
Practice Address - Street 1:3600 DE SOUZA PL
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5110
Practice Address - Country:US
Practice Address - Phone:661-834-3600
Practice Address - Fax:661-834-3605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice