Provider Demographics
NPI:1083841662
Name:SHEWANICK, BRYAN (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SHEWANICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 E 69 HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2515
Mailing Address - Country:US
Mailing Address - Phone:816-454-1313
Mailing Address - Fax:816-454-5377
Practice Address - Street 1:244 E 69 HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2515
Practice Address - Country:US
Practice Address - Phone:816-454-1313
Practice Address - Fax:816-454-5377
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist