Provider Demographics
NPI:1720186026
Name:SHEN, LINDA L (DDS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:SHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-0503
Mailing Address - Country:US
Mailing Address - Phone:570-708-4141
Mailing Address - Fax:570-708-3106
Practice Address - Street 1:10 RITTENHOUSE PLACE
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-0503
Practice Address - Country:US
Practice Address - Phone:570-708-4141
Practice Address - Fax:570-708-3106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist