MEDICARE: JAMES TODD SHANER 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	122300000X	Dentist	2010019899	MO
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2010019899	MO

General Provider Information

NPI Number	:	1952617698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES TODD SHANER DDS

Provider Business Mailing Address
First Line	:	5005 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79920-5002
Country	:	US
Telephone Number	:	915-742-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 N PIEDRAS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79920-5002
Country	:	US
Telephone Number	:	915-742-5711
Fax Number	:

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

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	07/21/2022

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