Provider Demographics
NPI:1407854433
Name:PARSONS, SHANE ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ALLEN
Last Name:PARSONS
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 1:1001 SW HURBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4615
Mailing Address - Country:US
Mailing Address - Phone:541-574-0275
Mailing Address - Fax:541-574-9013
Practice Address - Street 1:1001 SW HURBERT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4615
Practice Address - Country:US
Practice Address - Phone:541-574-0275
Practice Address - Fax:541-574-9013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice