Provider Demographics
NPI:1407218498
Name:DENDAUW, SHANTELL E (RDH)
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:E
Last Name:DENDAUW
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 1:1221 DISK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6638
Mailing Address - Country:US
Mailing Address - Phone:541-500-0959
Mailing Address - Fax:
Practice Address - Street 1:906 ROYAL CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6139
Practice Address - Country:US
Practice Address - Phone:541-500-0959
Practice Address - Fax:541-816-4275
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6914124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist