Provider Demographics
NPI:1407349004
Name:BEALS, SHAWN SHUMWAY
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:SHUMWAY
Last Name:BEALS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 E MCKINNEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-7557
Mailing Address - Country:US
Mailing Address - Phone:928-792-3558
Mailing Address - Fax:
Practice Address - Street 1:5150 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4904
Practice Address - Country:US
Practice Address - Phone:915-730-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice