Provider Demographics
NPI:1265213441
Name:BUERCK, SHANA MARIE (LDH, DT)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:MARIE
Last Name:BUERCK
Suffix:
Gender:F
Credentials:LDH, DT
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:MARIE
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDH
Mailing Address - Street 1:108 BICHNER LN
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-6810
Mailing Address - Country:US
Mailing Address - Phone:651-983-1429
Mailing Address - Fax:
Practice Address - Street 1:2442 COUNTY HWY 10
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:763-316-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT159125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist