Provider Demographics
NPI:1609137876
Name:CASHMAN, SHANE WESLY (DDS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:WESLY
Last Name:CASHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6303
Mailing Address - Country:US
Mailing Address - Phone:918-591-5721
Mailing Address - Fax:
Practice Address - Street 1:1313 E 20TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6303
Practice Address - Country:US
Practice Address - Phone:918-591-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice