Provider Demographics
NPI:1134826803
Name:LI, AILEEN SHEN
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:SHEN
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10885 REGAL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1517
Mailing Address - Country:US
Mailing Address - Phone:770-910-0610
Mailing Address - Fax:
Practice Address - Street 1:300 PEARL NIX PKWY STE D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3581
Practice Address - Country:US
Practice Address - Phone:770-282-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist