Provider Demographics
NPI:1477390862
Name:DONG, SHIQI (DDS)
Entity type:Individual
Prefix:DR
First Name:SHIQI
Middle Name:
Last Name:DONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:89 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4621
Mailing Address - Country:US
Mailing Address - Phone:780-938-1567
Mailing Address - Fax:
Practice Address - Street 1:625 ELMWOOD AVE # 683
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2913
Practice Address - Country:US
Practice Address - Phone:585-275-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program