MEDICARE: SHAUN SIGURDSON

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	31895	TX

General Provider Information

NPI Number	:	1467803643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN SIGURDSON

Provider Business Mailing Address
First Line	:	3302 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6434 E MOCKINGBIRD LN STE 215
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2494
Country	:	US
Telephone Number	:	214-827-1885
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	05/22/2020

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Directions to “ SHAUN SIGURDSON ” Practice Location

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