Provider Demographics
NPI:1073724944
Name:SHEARER, MANDY LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:LOUISE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10932 CAMPUS ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2704
Mailing Address - Country:US
Mailing Address - Phone:909-796-0036
Mailing Address - Fax:
Practice Address - Street 1:1612 GUNBARREL RD
Practice Address - Street 2:SUITE #301
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4135
Practice Address - Country:US
Practice Address - Phone:423-894-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54711122300000X
TN8576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist