Provider Demographics
NPI:1952321283
Name:SHANE SAMY D.M.D.,P.C.
Entity Type:Organization
Organization Name:SHANE SAMY D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-686-2931
Mailing Address - Street 1:2233 WILLAMETTE ST.,BLDG D
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-686-2931
Mailing Address - Fax:541-686-4500
Practice Address - Street 1:2233 WILLAMETTE ST.,BLDG D
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-686-2931
Practice Address - Fax:541-686-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherWILLIAM C. EARHEART
OR=========OtherASSOCIATED ADMIN. INC.
MO=========OtherKANSAS CITY LIFE
TX=========OtherMETLIFE
UT=========OtherREGENCE BCBS
OR=========OtherADVANTAGE DENTAL
IA=========OtherFORTIS BENEFITS
CA=========OtherDELTA DENTAL OF CA
OR=========OtherTHE ODS COMPANIES
OR=========OtherA&I BENEFIT PLAN
KY=========OtherAETNA DENTAL
MO=========OtherGREAT WEST HEALTHCARE
CA=========OtherJEFFERSON PILOT
OR=========OtherPACIFIC SOURCE
NY=========OtherSECURITY LIFE INS.
OR=========OtherTHE ODS CO.
OR=========OtherWASHING DENTAL
CA=========OtherTRICARE DELTA DENTAL
CA=========OtherPACIFICARE
NE=========OtherSTANDARD INS. CO.