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Individual

MRS. SHAWN ELIZABETH WILD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
10602 CHAPMAN AVE STE 200, GARDEN GROVE, CA 92840-3147
(714) 537-7900
Mailing address
2000 FORD LN, PLACENTIA, CA 92870-5500
(562) 743-4126

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
18779
CA

Other

Enumeration date
10/23/2017
Last updated
10/23/2017
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