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General NPI Number Information
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NPI Number | 1225200173
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Entity Type | Organization
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Legal Business Name | SHAWN T ENGEBRETSEN DMD P A
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 841 E OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34994-2427
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Country | US
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Telephone | 772-223-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 NW BRIGHT RIVER PT
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City | STUART
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State | FL
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Zip | 34994-9407
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Country | US
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Telephone | 772-692-1194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN T ENGEBRETSEN
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Credential | DMD PA
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Telephone | 772-223-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN0009427
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License Number State | FL
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