Provider Demographics
NPI:1710160411
Name:MCGUIRE, MICHAEL SHON (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHON
Last Name:MCGUIRE
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 1:2102 TURMALINE CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5883
Mailing Address - Country:US
Mailing Address - Phone:406-449-4971
Mailing Address - Fax:
Practice Address - Street 1:2102 TURMALINE CT
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5883
Practice Address - Country:US
Practice Address - Phone:406-449-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT01834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0130143Medicaid