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NPI 1639293590

NPI 1639293590 : JOSEPH MICHAEL SHURINA RDH : HARLEM, MT

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General NPI Number Information
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    NPI Number           |    1639293590
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    Entity Type          |    Individual 
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    Provider Name        |    JOSEPH MICHAEL SHURINA RDH
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    03/18/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    RR 1 BOX 67 
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    City                 |    HARLEM
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    State                |    MT
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    Zip                  |    59526-9705
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    Country              |    US
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    Telephone            |    406-353-3168
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    Fax                  |    406-353-3227
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Provider Business Mailing Address
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    Address Line         |    1225 14TH AVE 
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    City                 |    HAVRE
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    State                |    MT
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    Zip                  |    59501-4687
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    Country              |    US
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    Telephone            |    406-265-5911
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    Fax                  |    406-353-3227
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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        |    124Q00000X
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    Taxonomy Name        |    Dental Hygienist
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    License Number       |    1132
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    License Number State |    MT
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