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General NPI Number Information
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NPI Number | 1821385220
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Entity Type | Organization
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Legal Business Name | KEVIN P SHEARER, INC.
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 701 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2133
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Country | US
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Telephone | 539-926-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 701 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2133
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Country | US
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Telephone | 539-926-6333
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN P SHEARER
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Credential | D.D.S.
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Telephone | 530-926-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60469
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License Number State | CA
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