Provider Demographics
NPI:1366819096
Name:TREYNOR, SHELLEY L (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:L
Last Name:TREYNOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N STATE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9702
Mailing Address - Country:US
Mailing Address - Phone:989-831-5237
Mailing Address - Fax:989-831-5522
Practice Address - Street 1:615 N STATE ST
Practice Address - Street 2:STE 1
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-831-5237
Practice Address - Fax:989-831-3666
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist