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NPI Code Detail

MEDICARE: DR. TANYA LYNN SHORES D.M.D.

MEDICARE: DR. TANYA LYNN SHORES D.M.D.
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
1122300000XDentistDN014451GA
2122300000XDentist8118SC

General Provider Information

NPI Number : 1285986067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TANYA LYNN SHORES D.M.D.
Provider Business Mailing Address
First Line : 1210 GEORE C. WILSON DR.
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-4501
Country : US
Telephone Number : 706-855-8818
Fax Number : 706-855-0534
Provider Business Practice Location Address
First Line : 1210 GEORE C. WILSON DR.
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-4501
Country : US
Telephone Number : 706-855-8818
Fax Number : 706-855-0534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2012
Last Update Date : 10/04/2012

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