MEDICARE: KEVIN P SHEARER, INC.

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	1223G0001X	General Practice Dentistry	60469	CA

General Provider Information

NPI Number	:	1821385220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN P SHEARER, INC.

Provider Business Mailing Address
First Line	:	701 PINE ST
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2133
Country	:	US
Telephone Number	:	539-926-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 PINE ST
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2133
Country	:	US
Telephone Number	:	539-926-6333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN P SHEARER
Credential	:	D.D.S.
Telephone Number	:	530-926-6333

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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