Provider Demographics
NPI:1235397548
Name:MCCUE, SHAWN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:MCCUE
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 1:2924 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9702
Mailing Address - Country:US
Mailing Address - Phone:608-798-4600
Mailing Address - Fax:
Practice Address - Street 1:2924 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-9702
Practice Address - Country:US
Practice Address - Phone:608-798-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4889-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist