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General NPI Number Information
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NPI Number | 1437235769
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Entity Type | Organization
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Legal Business Name | JL SHAUGHNESSY DENTAL ASSOCIATES
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 42104 N VENTURE COURT BLDG E SUITE 103
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City | ANTHEM
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State | AZ
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Zip | 85086
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Country | US
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Telephone | 623-551-9200
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Fax | 623-551-9102
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Provider Business Mailing Address
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Address Line | 42104 N VENTURE COURT BLDG E SUITE 103
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City | ANTHEM
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State | AZ
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Zip | 85086
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Country | US
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Telephone | 623-551-9200
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Fax | 623-551-9102
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Authorized Official
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Title or Position | OWNER/HYGIENIST
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Name | MRS. JAMMIE SHAUGHNESSY
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Credential | RDH
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Telephone | 623-551-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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