Provider Demographics
NPI:1114289477
Name:PERRYMAN, SHAUN D (DDS, MBA)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:D
Last Name:PERRYMAN
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 LA CANTERA PKWY APT 12507
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2489
Mailing Address - Country:US
Mailing Address - Phone:706-294-3097
Mailing Address - Fax:
Practice Address - Street 1:4522 FREDERICKSBUG RD.
Practice Address - Street 2:STE A28
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201
Practice Address - Country:US
Practice Address - Phone:210-354-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics