Provider Demographics
NPI:1508600032
Name:SHA, CHENGCHENG (DMD)
Entity type:Individual
Prefix:
First Name:CHENGCHENG
Middle Name:
Last Name:SHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GIOIA
Other - Middle Name:
Other - Last Name:SHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4233 CHESTNUT ST UNIT 722
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6081
Mailing Address - Country:US
Mailing Address - Phone:608-504-5023
Mailing Address - Fax:
Practice Address - Street 1:8012 112TH STREET CT E STE 320
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7856
Practice Address - Country:US
Practice Address - Phone:253-848-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61560393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist