Provider Demographics
NPI:1891867933
Name:MCQUEEN, SHAUN L (DDS)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:L
Last Name:MCQUEEN
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 1:2225 BROADWATER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-652-3031
Mailing Address - Fax:406-652-3012
Practice Address - Street 1:2225 BROADWATER AVENUE
Practice Address - Street 2:2225 BROADWATER AVENUE
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-652-3031
Practice Address - Fax:406-652-3012
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2190Medicare UPIN