Provider Demographics
NPI:1003080037
Name:GREGORY S. SHANBOUR, D.D.S., M.S.
Entity Type:Organization
Organization Name:GREGORY S. SHANBOUR, D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHANBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-634-2239
Mailing Address - Street 1:8117 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9476
Mailing Address - Country:US
Mailing Address - Phone:405-634-2239
Mailing Address - Fax:405-634-3598
Practice Address - Street 1:8117 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9476
Practice Address - Country:US
Practice Address - Phone:405-634-2239
Practice Address - Fax:405-634-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty