=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679674568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERNON LYN SHEEN D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 01/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 BESTGATE RD SUITE 201
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-3091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-266-1007
-----------------------------------------------------
Fax | 410-266-3850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 888 BESTGATE RD STE 201
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-2953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-266-1007
-----------------------------------------------------
Fax | 410-266-3850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 10502
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------