Provider Demographics
NPI:1134657737
Name:NEW, SHANE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:LYNN
Last Name:NEW
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 1:1700 W SMITH VALLEY RD STE C2
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1589
Mailing Address - Country:US
Mailing Address - Phone:317-888-6684
Mailing Address - Fax:317-888-6687
Practice Address - Street 1:1700 W SMITH VALLEY RD STE C2
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1589
Practice Address - Country:US
Practice Address - Phone:317-888-6684
Practice Address - Fax:317-888-6687
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012715A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist