Provider Demographics
NPI:1518005024
Name:SHEN, DAVID T (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:SHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:650-589-1155
Practice Address - Street 1:883 SNEATH LANE
Practice Address - Street 2:#130
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-589-4563
Practice Address - Fax:650-589-1155
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics