Provider Demographics
NPI:1437572476
Name:TAN, SHIRLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:TAN
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 1:1487 TRADEWINDS
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3374
Mailing Address - Country:US
Mailing Address - Phone:626-851-1657
Mailing Address - Fax:
Practice Address - Street 1:1487 TRADEWINDS
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3374
Practice Address - Country:US
Practice Address - Phone:626-851-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist