MEDICARE: DR. JEFFREY D SHAWBERRY 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	1223G0001X	General Practice Dentistry	30-021085	OH

General Provider Information

NPI Number	:	1871698324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D SHAWBERRY DDS

Provider Business Mailing Address
First Line	:	66 ASHWOOD DR
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-1908
Country	:	US
Telephone Number	:	419-447-1851
Fax Number	:	419-447-0397

Provider Business Practice Location Address
First Line	:	66 ASHWOOD DR
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-1908
Country	:	US
Telephone Number	:	419-447-1851
Fax Number	:	419-447-0397

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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