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NPI Code Detail

MEDICARE: SHAWN EVERINGHAM EVERINGHAM RDH

MEDICARE: SHAWN EVERINGHAM EVERINGHAM RDH
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
1124Q00000XDental Hygienist1549AZ

General Provider Information

NPI Number : 1356533301
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN EVERINGHAM EVERINGHAM RDH
Provider Business Mailing Address
First Line : 5066 W KINGBIRD ST
Second Line :
City : TUCSON
State : AZ
Zip : 85742-5115
Country : US
Telephone Number : 520-248-2155
Fax Number :
Provider Business Practice Location Address
First Line : 5066 W KINGBIRD ST
Second Line :
City : TUCSON
State : AZ
Zip : 85742-5115
Country : US
Telephone Number : 520-248-2155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 08/14/2007

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Directions to “ SHAWN EVERINGHAM EVERINGHAM RDH” Practice Location

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