Provider Demographics
NPI:1376675769
Name:SHAMBARGER, SANDRA LYNN (DDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:SHAMBARGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4109
Mailing Address - Country:US
Mailing Address - Phone:903-792-3636
Mailing Address - Fax:
Practice Address - Street 1:2800 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4109
Practice Address - Country:US
Practice Address - Phone:903-792-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics