Provider Demographics
NPI:1538265715
Name:SHEN, DONG (DDS)
Entity type:Individual
Prefix:DR
First Name:DONG
Middle Name:
Last Name:SHEN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:DONIAN
Other - Middle Name:
Other - Last Name:SHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:105 SOUTH DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4317
Mailing Address - Country:US
Mailing Address - Phone:650-938-1868
Mailing Address - Fax:650-938-1968
Practice Address - Street 1:105 SOUTH DR STE 140
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4317
Practice Address - Country:US
Practice Address - Phone:650-938-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53106122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist