Provider Demographics
NPI:1437235769
Name:JL SHAUGHNESSY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:JL SHAUGHNESSY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAUGHNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:623-551-9200
Mailing Address - Street 1:42104 N VENTURE COURT
Mailing Address - Street 2:BLDG E SUITE 103
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-9200
Mailing Address - Fax:623-551-9102
Practice Address - Street 1:42104 N VENTURE COURT
Practice Address - Street 2:BLDG E SUITE 103
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-9200
Practice Address - Fax:623-551-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental