MEDICARE: SHAUNIELL DEARING DDS

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	11297888-9922	UT

General Provider Information

NPI Number	:	1396302055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNIELL DEARING DDS

Provider Business Mailing Address
First Line	:	254 BIRMINGHAM LN
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6035
Country	:	US
Telephone Number	:	801-787-6343
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 BIRMINGHAM LN
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6035
Country	:	US
Telephone Number	:	801-787-6343
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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Directions to “ SHAUNIELL DEARING DDS” Practice Location

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