Provider Demographics
NPI:1568148104
Name:SHANER, LUKE DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:DAVID
Last Name:SHANER
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 1:1 BOSTON WAY UNIT 106
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4181
Mailing Address - Country:US
Mailing Address - Phone:360-480-3224
Mailing Address - Fax:
Practice Address - Street 1:154 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4759
Practice Address - Country:US
Practice Address - Phone:603-673-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice