MEDICARE: DR. JOHN C MCSHANE D.M.D.

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	PA18202L	PA

General Provider Information

NPI Number	:	1356553622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C MCSHANE D.M.D.

Provider Business Mailing Address
First Line	:	3909 WASHINGTON RD
Second Line	:	SUITE 310
City	:	MCMURRAY
State	:	PA
Zip	:	15317-2544
Country	:	US
Telephone Number	:	724-941-5272
Fax Number	:	724-942-3231

Provider Business Practice Location Address
First Line	:	3909 WASHINGTON RD
Second Line	:	SUITE 310
City	:	MCMURRAY
State	:	PA
Zip	:	15317-2544
Country	:	US
Telephone Number	:	724-941-5272
Fax Number	:	724-942-3231

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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