Healthcare Provider Details

I. General information

NPI: 1770694721
Provider Name (Legal Business Name): SHAWN R NALLY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 THE PKWY
GREER SC
29650-4569
US

IV. Provider business mailing address

394 THE PKWY
GREER SC
29650-4569
US

V. Phone/Fax

Practice location:
  • Phone: 864-848-3640
  • Fax: 864-848-3646
Mailing address:
  • Phone: 864-848-3640
  • Fax: 864-848-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3230
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: