Provider Demographics
NPI:1053710673
Name:SHANG, KE (DMD)
Entity type:Individual
Prefix:DR
First Name:KE
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WESTFALL RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2635
Mailing Address - Country:US
Mailing Address - Phone:585-756-5566
Mailing Address - Fax:585-756-5567
Practice Address - Street 1:900 WESTFALL RD STE C
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2635
Practice Address - Country:US
Practice Address - Phone:585-756-5566
Practice Address - Fax:585-756-5567
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0596401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics