Provider Demographics
NPI:1043320351
Name:SZABO, SHAUNNA JOLANDA (DMD)
Entity Type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:JOLANDA
Last Name:SZABO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N SHORE DR UNIT 835
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4405
Mailing Address - Country:US
Mailing Address - Phone:843-697-7440
Mailing Address - Fax:
Practice Address - Street 1:1070 HIGHWAY 501 BUSINESS
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9588
Practice Address - Country:US
Practice Address - Phone:843-347-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411014122300000X
SC4514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA107271Medicaid