| |
105 South Dr Suite 140 Mountain View CA 94040-4311 | |
(650) 938-1868 | |
(650) 938-1968 |
Full Name | |
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Speciality | Dentist |
Location | 105 South Dr, Mountain View, California |
Authorized Official Name and Position | Dong Shen (PRESIDENT) |
Authorized Official Contact | 6509381868 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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105 South Dr Suite 140 Mountain View CA 94040-4311 Ph: (650) 938-1868 | 105 South Dr Suite 140 Mountain View CA 94040-4311 Ph: (650) 938-1868 |
NPI Number | 1912343831 |
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Provider Enumeration Date | 05/18/2013 |
Last Update Date | 10/30/2024 |
Medicare PECOS PAC ID | 1153561162 |
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Medicare Enrollment ID | O20130715000436 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912343831 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Provider Name | Dong Shen |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1538265715 PECOS PAC ID: 2062652076 Enrollment ID: I20130715000444 |
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