Provider Demographics
NPI:1568829562
Name:DAVID SHEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:DAVID SHEN DENTAL CORPORATION
Other - Org Name:ORTHOWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TAI MAN
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-589-4563
Mailing Address - Street 1:883 SNEATH LN
Mailing Address - Street 2:#130
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2409
Mailing Address - Country:US
Mailing Address - Phone:650-589-4563
Mailing Address - Fax:
Practice Address - Street 1:877 W FREMONT AVE STE J2
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2332
Practice Address - Country:US
Practice Address - Phone:408-738-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOWORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD284871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty