Provider Demographics
NPI:1487764767
Name:SHIH, PRISCILLA H (DDS)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:H
Last Name:SHIH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:SHIH
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1403 WATERLOO AVE
Mailing Address - Street 2:WATERLOO HEIGHTS DENTAL
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-9270
Mailing Address - Country:US
Mailing Address - Phone:608-786-0909
Mailing Address - Fax:
Practice Address - Street 1:1403 WATERLOO AVE
Practice Address - Street 2:WATERLOO HEIGHTS DENTAL
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9270
Practice Address - Country:US
Practice Address - Phone:608-786-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190160171223G0001X
WI5953015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS7686756OtherDEA