Provider Demographics
NPI:1487843728
Name:DAVID SHEN DENTAL CORP
Entity Type:Organization
Organization Name:DAVID SHEN DENTAL CORP
Other - Org Name:ORTHOWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-589-4563
Mailing Address - Street 1:883 SNEATH LANE
Mailing Address - Street 2:#130
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-589-4563
Mailing Address - Fax:
Practice Address - Street 1:5117 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-777-9922
Practice Address - Fax:925-777-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty