Provider Demographics
NPI:1760649735
Name:SHAYNE, MARY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY LYNN
Middle Name:
Last Name:SHAYNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 E BATTLEFIELD ROAD
Mailing Address - Street 2:SUITE S
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4081
Mailing Address - Country:US
Mailing Address - Phone:417-882-3335
Mailing Address - Fax:417-882-3435
Practice Address - Street 1:3250 E BATTLEFIELD ROAD
Practice Address - Street 2:SUITE S
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4081
Practice Address - Country:US
Practice Address - Phone:417-882-3335
Practice Address - Fax:417-882-3435
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO015341OtherMISSOURI DENTAL BOARD