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General NPI Number Information
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NPI Number | 1366826224
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Entity Type | Individual
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Provider Name | SHAUN THOMAS HEWARD DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 5742 S 1475 E STE 100
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4857
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Country | US
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Telephone | 801-479-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 5742 S 1475 E STE 100
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4857
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Country | US
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Telephone | 801-479-9070
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2901021498
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12210727-9925
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License Number State | UT
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