Provider Demographics
NPI:1861446783
Name:SHAUGHNESSY, KATHLEEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:WARTHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HQS, U.S. ARMY DENTAL ACTIVITY
Mailing Address - Street 2:51005 WINANS RILEY BARRACKS EAST WING
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7040
Mailing Address - Country:US
Mailing Address - Phone:520-533-3144
Mailing Address - Fax:520-533-7285
Practice Address - Street 1:HQS, U.S. ARMY DENTAL ACTIVITY
Practice Address - Street 2:51005 WINANS RILEY BARRACKS EAST WING
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7040
Practice Address - Country:US
Practice Address - Phone:520-533-3144
Practice Address - Fax:520-533-7285
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice