Healthcare Provider Details

I. General information

NPI: 1972804896
Provider Name (Legal Business Name): WILLIAM JERRY BARNET SHEARER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUARTERMASTER ROAD SAIPAN SEVENTH-DAY ADVENTIST CLINIC
SAIPAN MP
96950
US

IV. Provider business mailing address

P.O. BOX 500169 SAIPAN SEVENTH-DAY ADVENTIST CLINIC
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-6008
  • Fax: 670-234-0521
Mailing address:
  • Phone: 670-234-6008
  • Fax: 670-234-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9163
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0113
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: