Provider Demographics
NPI:1245249820
Name:SHEN, XUE YU (DMD)
Entity type:Individual
Prefix:
First Name:XUE YU
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LINDEN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-755-0008
Mailing Address - Fax:508-770-0603
Practice Address - Street 1:9 LINDEN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:508-755-0008
Practice Address - Fax:508-770-0603
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
X09042OtherBCBS
MA0204218Medicaid
MASHX20121Medicare ID - Type Unspecified
MA0204218Medicaid