Provider Demographics
NPI:1932510815
Name:BURLINGAME, SHAUN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BURLINGAME
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17829 RANCHERA RD
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-8954
Mailing Address - Country:US
Mailing Address - Phone:801-718-1102
Mailing Address - Fax:
Practice Address - Street 1:316 KNOLLCREST DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0104
Practice Address - Country:US
Practice Address - Phone:530-223-1811
Practice Address - Fax:530-223-1813
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1705821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery