Healthcare Provider Details

I. General information

NPI: 1306069299
Provider Name (Legal Business Name): ROBERT LAFORREST SHOUN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 CEDARCREST DR
LEXINGTON SC
29072-3812
US

IV. Provider business mailing address

253 CEDARCREST DR
LEXINGTON SC
29072-3812
US

V. Phone/Fax

Practice location:
  • Phone: 803-951-7337
  • Fax:
Mailing address:
  • Phone: 803-348-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3801
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: