Provider Demographics
NPI:1942445689
Name:SHEN'S SMILES PC
Entity Type:Organization
Organization Name:SHEN'S SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-956-9962
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:570-956-9962
Mailing Address - Fax:
Practice Address - Street 1:10 RITTENHOUSE PLACE
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222
Practice Address - Country:US
Practice Address - Phone:570-956-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035064261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental