Provider Demographics
NPI:1124560545
Name:WEIL, SHAUNA (RDH)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:WEIL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:MAYGRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:8909 NE 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3059
Mailing Address - Country:US
Mailing Address - Phone:985-707-4657
Mailing Address - Fax:
Practice Address - Street 1:13115 NE 4TH ST STE 250
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5960
Practice Address - Country:US
Practice Address - Phone:360-256-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6880124Q00000X
WADH60491467124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist