Provider Demographics
NPI:1619197019
Name:CULLIMORE, SHAUN R (DMD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:R
Last Name:CULLIMORE
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 1:1300 N MCCLINTOCK DR
Mailing Address - Street 2:SUITE B2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7205
Mailing Address - Country:US
Mailing Address - Phone:480-777-9938
Mailing Address - Fax:
Practice Address - Street 1:1300 N MCCLINTOCK DR
Practice Address - Street 2:SUITE B2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-7205
Practice Address - Country:US
Practice Address - Phone:480-777-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics