Provider Demographics
NPI:1497497069
Name:SHEN, JESSICA HUIYING (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HUIYING
Last Name:SHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 SKEET CLUB RD STE 150
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8820
Mailing Address - Country:US
Mailing Address - Phone:336-450-2078
Mailing Address - Fax:
Practice Address - Street 1:1589 SKEET CLUB RD STE 150
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8820
Practice Address - Country:US
Practice Address - Phone:336-450-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13060122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist