Provider Demographics
NPI:1356553622
Name:MCSHANE, JOHN C (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MCSHANE
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 1:3909 WASHINGTON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2544
Mailing Address - Country:US
Mailing Address - Phone:724-941-5272
Mailing Address - Fax:724-942-3231
Practice Address - Street 1:3909 WASHINGTON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2544
Practice Address - Country:US
Practice Address - Phone:724-941-5272
Practice Address - Fax:724-942-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA18202L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice