MEDICARE: DR. JOHN DAVID SHURTZ D.D.S.

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	D7050	OR

General Provider Information

NPI Number	:	1841288545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID SHURTZ D.D.S.

Provider Business Mailing Address
First Line	:	196 CATRON ST. N.
Second Line	:
City	:	MONMOUTH
State	:	OR
Zip	:	97361-2303
Country	:	US
Telephone Number	:	503-838-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 CATRON ST. N.
Second Line	:
City	:	MONMOUTH
State	:	OR
Zip	:	97361-2303
Country	:	US
Telephone Number	:	503-838-1800
Fax Number	:	503-838-7210

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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