Provider Demographics
NPI:1427118918
Name:SHISHIMA, MARC H (DDS)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:H
Last Name:SHISHIMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S GARFIELD AVE
Mailing Address - Street 2:#216
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-289-1148
Mailing Address - Fax:626-289-8327
Practice Address - Street 1:330 S GARFIELD AVE
Practice Address - Street 2:#216
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-289-1148
Practice Address - Fax:626-289-8327
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist