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General NPI Number Information
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NPI Number | 1932510815
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Entity Type | Individual
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Provider Name | SHAUN BURLINGAME DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 316 KNOLLCREST DR
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City | REDDING
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State | CA
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Zip | 96002-0104
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Country | US
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Telephone | 530-223-1811
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Fax | 530-223-1813
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Provider Business Mailing Address
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Address Line | 17829 RANCHERA RD
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City | SHASTA LAKE
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State | CA
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Zip | 96019-8954
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Country | US
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Telephone | 801-718-1102
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 170582
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License Number State | CA
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