Healthcare Provider Details

I. General information

NPI: 1073724944
Provider Name (Legal Business Name): MANDY LOUISE SHEARER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9759 DAYTON PIKE
SODDY DAISY TN
37379-4729
US

IV. Provider business mailing address

9759 DAYTON PIKE
SODDY DAISY TN
37379-4729
US

V. Phone/Fax

Practice location:
  • Phone: 423-332-5275
  • Fax:
Mailing address:
  • Phone: 423-332-5275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8576
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: