Provider Demographics
NPI:1760571103
Name:MAY, SHAWN ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ALLEN
Last Name:MAY
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 1:209 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1271
Mailing Address - Country:US
Mailing Address - Phone:217-450-7535
Mailing Address - Fax:618-212-9054
Practice Address - Street 1:6407 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2720
Practice Address - Country:US
Practice Address - Phone:618-310-0263
Practice Address - Fax:618-212-9054
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027153122300000X
MO20180289361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice