MEDICARE: DR. OWEN MCSHANE DDS

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	122300000X	Dentist	042411	NY

General Provider Information

NPI Number	:	1649354010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OWEN MCSHANE DDS

Provider Business Mailing Address
First Line	:	3 SAINT STEPHENS PL
Second Line	:	STE1
City	:	WARWICK
State	:	NY
Zip	:	10990-3208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 SAINT STEPHENS PL
Second Line	:	STE1
City	:	WARWICK
State	:	NY
Zip	:	10990-3208
Country	:	US
Telephone Number	:	845-986-6866
Fax Number	:	845-988-5515

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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