Provider Demographics
NPI:1679798508
Name:MAGELSEN, SHAWN F (DMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:F
Last Name:MAGELSEN
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 1:7327 73RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7762
Mailing Address - Country:US
Mailing Address - Phone:360-659-8031
Mailing Address - Fax:
Practice Address - Street 1:9612 270TH ST NW
Practice Address - Street 2:SUITE F
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-1906
Practice Address - Country:US
Practice Address - Phone:360-629-1776
Practice Address - Fax:360-629-0541
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist