Provider Demographics
NPI:1992358261
Name:MCNEES, SHAUN (DMD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:MCNEES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 SW CELESTE LN APT 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-7120
Mailing Address - Country:US
Mailing Address - Phone:907-440-0231
Mailing Address - Fax:
Practice Address - Street 1:2805 DAWSON ST STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3800
Practice Address - Country:US
Practice Address - Phone:907-562-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist