Provider Demographics
NPI:1689197808
Name:PLATT, SHAWN P (DMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:P
Last Name:PLATT
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 1:5715 CHARLIE CHAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2310
Mailing Address - Country:US
Mailing Address - Phone:503-989-1717
Mailing Address - Fax:
Practice Address - Street 1:1300 ESTHER ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2890
Practice Address - Country:US
Practice Address - Phone:360-693-4701
Practice Address - Fax:360-993-5299
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32798122300000X
WA608337371223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist