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General NPI Number Information
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NPI Number | 1235510967
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Entity Type | Individual
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Provider Name | MATTHEW BERNARD SHAUGHNESSY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 2962 STATE ROUTE 39
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City | MILLERSBURG
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State | OH
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Zip | 44654-8852
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Country | US
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Telephone | 330-893-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 9250 BEECHWOOD DR
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2647
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Country | US
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Telephone | 708-362-2594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.033443
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.24891
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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