Provider Demographics
NPI:1740629344
Name:SERGIE-SHAVINGS, XENIA M (PRIMARY DENTAL HEALT)
Entity type:Individual
Prefix:MRS
First Name:XENIA
Middle Name:M
Last Name:SERGIE-SHAVINGS
Suffix:
Gender:F
Credentials:PRIMARY DENTAL HEALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:MEKORYUK
Mailing Address - State:AK
Mailing Address - Zip Code:99630
Mailing Address - Country:US
Mailing Address - Phone:907-827-8111
Mailing Address - Fax:907-827-8351
Practice Address - Street 1:43 CHASE ROAD
Practice Address - Street 2:
Practice Address - City:MEKORYUK
Practice Address - State:AK
Practice Address - Zip Code:99630
Practice Address - Country:US
Practice Address - Phone:907-827-8111
Practice Address - Fax:907-827-8351
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other