Provider Demographics
NPI:1861046872
Name:SHEN, JOANNA
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 W CHARLESTON BLVD UNIT 1046
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9203
Mailing Address - Country:US
Mailing Address - Phone:626-203-7454
Mailing Address - Fax:
Practice Address - Street 1:1150 S NELLIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5700
Practice Address - Country:US
Practice Address - Phone:702-505-9159
Practice Address - Fax:702-505-9159
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist