Individual
ITIEN EMILY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MD
Contact information
Practice address
4170 TRUXEL RD STE C, SACRAMENTO, CA 95834-3758
(844) 673-9131
(916) 419-4582
Mailing address
4170 TRUXEL RD STE C, SACRAMENTO, CA 95834-3758
(844) 673-9131
(916) 419-4582
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DDS102837
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
04/13/2011
Last updated
05/16/2019
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