Provider Demographics
NPI:1801054259
Name:SHAMAYNE M. FRANK, DDS, PC
Entity type:Organization
Organization Name:SHAMAYNE M. FRANK, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMAYNE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-252-9894
Mailing Address - Street 1:321 W. 25TH ST.
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4029
Mailing Address - Country:US
Mailing Address - Phone:712-252-9894
Mailing Address - Fax:712-252-9065
Practice Address - Street 1:321 W. 25TH ST.
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4029
Practice Address - Country:US
Practice Address - Phone:712-252-9894
Practice Address - Fax:712-252-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64311223G0001X, 261QD0000X
SDM9991223G0001X, 261QD0000X
IA08224261QD0000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962417733Medicaid
SD7809990Medicaid
NE10025533200Medicaid
NE1002-5004500Medicaid
IA0566224Medicaid
SD7809990Medicaid