Provider Demographics
NPI:1184721243
Name:SHAUGHNESSY, JAMES WARREN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
Last Name:SHAUGHNESSY
Suffix:JR
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 1:800 ZORN AVE
Mailing Address - Street 2:VAMC DENTAL SERVICE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1433
Mailing Address - Country:US
Mailing Address - Phone:502-287-5352
Mailing Address - Fax:502-287-6174
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:VAMC DENTAL SERVICE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-5352
Practice Address - Fax:502-287-6174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice