Provider Demographics
NPI:1962486142
Name:SENDELBACK, SHONEEN S (DMD)
Entity Type:Individual
Prefix:
First Name:SHONEEN
Middle Name:S
Last Name:SENDELBACK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 MOUNTAIN VIEW LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2274
Mailing Address - Country:US
Mailing Address - Phone:503-357-2158
Mailing Address - Fax:503-357-0248
Practice Address - Street 1:1907 MOUNTAIN VIEW LN
Practice Address - Street 2:SUITE 400
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2274
Practice Address - Country:US
Practice Address - Phone:503-357-2158
Practice Address - Fax:503-357-0248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1638358OtherUNITED CONCORDIA