Provider Demographics
NPI:1568821635
Name:CHIYO SHIDARA D.D.S., APC
Entity Type:Organization
Organization Name:CHIYO SHIDARA D.D.S., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIYO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIDARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-741-7100
Mailing Address - Street 1:605 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1078
Mailing Address - Country:US
Mailing Address - Phone:415-699-5554
Mailing Address - Fax:925-822-3965
Practice Address - Street 1:2150 APPIAN WAY STE 208
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2520
Practice Address - Country:US
Practice Address - Phone:510-741-7100
Practice Address - Fax:510-741-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty