Provider Demographics
NPI:1700207123
Name:SHEHANE, JERRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:M
Last Name:SHEHANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 SHADOW MOSS WAY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3909
Mailing Address - Country:US
Mailing Address - Phone:214-334-7798
Mailing Address - Fax:
Practice Address - Street 1:1780 NORTHWEST HWY
Practice Address - Street 2:STE 150
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5220
Practice Address - Country:US
Practice Address - Phone:903-758-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106381223G0001X, 122300000X, 122300000X, 125K00000X, 125Q00000X, 207K00000X, 207P00000X, 207Q00000X, 207ZF0201X, 207ZP0102X, 2085R0202X, 2085R0205X, 208D00000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No125K00000XDental ProvidersAdvanced Practice Dental Therapist
No125Q00000XDental ProvidersOral Medicinist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology