Provider Demographics
NPI:1427524107
Name:SHI, SHUANG (DMD)
Entity type:Individual
Prefix:DR
First Name:SHUANG
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 SCOTTS VALLEY DR STE C
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4226
Mailing Address - Country:US
Mailing Address - Phone:831-438-0554
Mailing Address - Fax:
Practice Address - Street 1:4736 SCOTTS VALLEY DR STE C
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4226
Practice Address - Country:US
Practice Address - Phone:831-438-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist