MEDICARE: JOHN JUNJI SHINGU 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	1223G0001X	General Practice Dentistry	5619	WA

General Provider Information

NPI Number	:	1851374862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JUNJI SHINGU DDS

Provider Business Mailing Address
First Line	:	3926 CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-4023
Country	:	US
Telephone Number	:	360-754-6072
Fax Number	:	360-754-7817

Provider Business Practice Location Address
First Line	:	3926 CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-4023
Country	:	US
Telephone Number	:	360-754-6072
Fax Number	:	360-754-7817

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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