Provider Demographics
NPI:1558621086
Name:SHEN, YENSHUO (DMD)
Entity Type:Individual
Prefix:DR
First Name:YENSHUO
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ELTON HILLS LN NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3602
Mailing Address - Country:US
Mailing Address - Phone:507-288-8363
Mailing Address - Fax:507-288-4456
Practice Address - Street 1:116 ELTON HILLS LN NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3602
Practice Address - Country:US
Practice Address - Phone:507-288-8363
Practice Address - Fax:550-728-8445
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0390431223G0001X
MND136341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice