MEDICARE: DR. DEBORAH KAY SHEWBRIDGE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3100	WV

General Provider Information

NPI Number	:	1255485470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH KAY SHEWBRIDGE D.D.S.

Provider Business Mailing Address
First Line	:	116 W WASHINGTON ST
Second Line	:	SUITE 3A
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-1543
Country	:	US
Telephone Number	:	304-725-7613
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 W WASHINGTON ST
Second Line	:	SUITE 3A
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-1543
Country	:	US
Telephone Number	:	304-725-7613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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