MEDICARE: SHAYE DRUMMOND DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	39573	TX

General Provider Information

NPI Number	:	1780374934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYE DRUMMOND DMD

Provider Business Mailing Address
First Line	:	910 GUADALUPE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 GUADALUPE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5280
Country	:	US
Telephone Number	:	956-884-4840
Fax Number	:

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	06/13/2023

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Directions to “ SHAYE DRUMMOND DMD” Practice Location

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