Provider Demographics
NPI:1235341405
Name:SHENFIELD, GARY B (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:SHENFIELD
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 1:47 PENNY LN
Mailing Address - Street 2:STE. 2
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6055
Mailing Address - Country:US
Mailing Address - Phone:831-724-4539
Mailing Address - Fax:831-724-3619
Practice Address - Street 1:47 PENNY LN
Practice Address - Street 2:STE. 2
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6055
Practice Address - Country:US
Practice Address - Phone:831-724-4539
Practice Address - Fax:831-724-3619
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist