Individual
BO SHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
110 BERGEN ST, NEWARK, NJ 07103-2495
(973) 943-9346
Mailing address
407 CROSS ST, HARRISON, NJ 07029-1209
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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