Provider Demographics
NPI:1821385220
Name:KEVIN P SHEARER, INC.
Entity Type:Organization
Organization Name:KEVIN P SHEARER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-926-6333
Mailing Address - Street 1:701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2133
Mailing Address - Country:US
Mailing Address - Phone:539-926-6333
Mailing Address - Fax:
Practice Address - Street 1:701 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2133
Practice Address - Country:US
Practice Address - Phone:539-926-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty