Provider Demographics
NPI:1841875259
Name:RHODEN, SHAVONE (DDS)
Entity type:Individual
Prefix:
First Name:SHAVONE
Middle Name:
Last Name:RHODEN
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 1:8831 HARPERS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4544
Mailing Address - Country:US
Mailing Address - Phone:904-333-3881
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-8594
Practice Address - Country:US
Practice Address - Phone:352-273-6910
Practice Address - Fax:352-273-5717
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN27327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program