Healthcare Provider Details

I. General information

NPI: 1932545266
Provider Name (Legal Business Name): SHANE MARKEY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 W. ROOSEVELT BLVD SUITE A DENTISTRY OF THE CAROLINAS
MONROE NC
28110
US

IV. Provider business mailing address

10730 N ORACLE RD APT 15204
ORO VALLEY AZ
85737-9304
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-7100
  • Fax:
Mailing address:
  • Phone: 347-558-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9187
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number64312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: