Provider Demographics
NPI:1790871531
Name:TU, SHIN-ING JEREMY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHIN-ING
Middle Name:JEREMY
Last Name:TU
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:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0915
Mailing Address - Country:US
Mailing Address - Phone:319-626-2222
Mailing Address - Fax:319-626-6610
Practice Address - Street 1:115 N. HWY 965
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9237
Practice Address - Country:US
Practice Address - Phone:319-626-2222
Practice Address - Fax:319-626-6610
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21077191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279349Medicaid