Provider Demographics
NPI:1609146166
Name:SHAO, JEFF YUAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:YUAN
Last Name:SHAO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 SHOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4709
Mailing Address - Country:US
Mailing Address - Phone:210-343-0474
Mailing Address - Fax:
Practice Address - Street 1:7901 RESEARCH FOREST DR STE 1100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1484
Practice Address - Country:US
Practice Address - Phone:832-663-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273171223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice