Provider Demographics
NPI:1093770166
Name:MCAVOY, SHELLY DONEGAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:DONEGAN
Last Name:MCAVOY
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:US ARMY HOSPITAL HDENTAC CREDENTIALS OFFICE
Mailing Address - Street 2:KARLSRUHERSTR 144 NACHRICHTEN KASERNE BLDG 3607
Mailing Address - City:HEIDELBERG
Mailing Address - State:BADEN WURTEMBOURG
Mailing Address - Zip Code:69126
Mailing Address - Country:DE
Mailing Address - Phone:618-192-8639
Mailing Address - Fax:
Practice Address - Street 1:US ARMY HOSPITAL HDENTAC CREDENTIALS OFFICE
Practice Address - Street 2:KARLSRUHERSTR 144 NACHRICHTEN KASERNE BLDG 3607
Practice Address - City:HEIDELBERG
Practice Address - State:BADEN WURTEMBOURG
Practice Address - Zip Code:69126
Practice Address - Country:DE
Practice Address - Phone:618-192-8639
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 163211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice