Provider Demographics
NPI:1851848196
Name:SHIMANE, MARY JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:SHIMANE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20099 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4326
Mailing Address - Country:US
Mailing Address - Phone:510-881-1611
Mailing Address - Fax:
Practice Address - Street 1:20099 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4326
Practice Address - Country:US
Practice Address - Phone:510-881-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist