MEDICARE: SHAWN ALLEN MAY 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	019027153	IL
2	1223G0001X	General Practice Dentistry	2018028936	MO

General Provider Information

NPI Number	:	1760571103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN ALLEN MAY DDS

Provider Business Mailing Address
First Line	:	209 WILLIAMSBURG DR
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1271
Country	:	US
Telephone Number	:	217-450-7535
Fax Number	:	618-212-9054

Provider Business Practice Location Address
First Line	:	6407 N ILLINOIS ST
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2720
Country	:	US
Telephone Number	:	618-310-0263
Fax Number	:	618-212-9054

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/02/2022

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