Provider Demographics
NPI:1891897930
Name:LA, SHIRLEY QUYEN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:QUYEN
Last Name:LA
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 1:5231 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2817
Mailing Address - Country:US
Mailing Address - Phone:415-668-3688
Mailing Address - Fax:415-379-1818
Practice Address - Street 1:5231 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2817
Practice Address - Country:US
Practice Address - Phone:415-668-3688
Practice Address - Fax:415-379-1818
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice