Provider Demographics
NPI:1275753014
Name:MCDOWELL, SHANE RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:RYAN
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 CAMBRIDGE MANOR PL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3620
Mailing Address - Country:US
Mailing Address - Phone:239-936-0597
Mailing Address - Fax:239-936-0582
Practice Address - Street 1:7711 CAMBRIDGE MANOR PL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3620
Practice Address - Country:US
Practice Address - Phone:239-936-0597
Practice Address - Fax:239-936-0582
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice