Provider Demographics
NPI:1871823963
Name:SHREWSBERRY, CECIL ROSCO IV (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:ROSCO
Last Name:SHREWSBERRY
Suffix:IV
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:3231 WOODWARD DR STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4101
Mailing Address - Country:US
Mailing Address - Phone:936-755-5750
Mailing Address - Fax:210-519-0082
Practice Address - Street 1:3231 WOODWARD DR STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4101
Practice Address - Country:US
Practice Address - Phone:936-755-5750
Practice Address - Fax:210-519-0082
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2019-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA55051223S0112X
TX251781223S0112X
TXN8147204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery