MEDICARE: DR. JENNIFER SHAWN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D7686	OR

General Provider Information

NPI Number	:	1306043724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER SHAWN DMD

Provider Business Mailing Address
First Line	:	9370 SW GREENBURG RD STE T
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5408
Country	:	US
Telephone Number	:	503-227-0535
Fax Number	:

Provider Business Practice Location Address
First Line	:	9370 SW GREENBURG RD STE T
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5408
Country	:	US
Telephone Number	:	503-227-0535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/21/2014

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