Healthcare Provider Details

I. General information

NPI: 1205826823
Provider Name (Legal Business Name): BARBARA E. SHANHOLTZER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD
MACDILL AFB FL
33621
US

IV. Provider business mailing address

1397 CRESCENT DR
LARGO FL
33770-4258
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9422
  • Fax:
Mailing address:
  • Phone: 727-581-4708
  • Fax: 727-581-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000852
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: