Provider Demographics
NPI:1740151935
Name:SHEN, CHRISTIE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ASHLAND PL # 2105
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1108
Mailing Address - Country:US
Mailing Address - Phone:626-298-9187
Mailing Address - Fax:
Practice Address - Street 1:180 ASHLAND PL # 2105
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1108
Practice Address - Country:US
Practice Address - Phone:626-298-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0650681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics