Provider Demographics
NPI:1932237070
Name:LEMERT, SHAWN LEVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LEVI
Last Name:LEMERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1729 W HARVARD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2795
Mailing Address - Country:US
Mailing Address - Phone:541-673-0924
Mailing Address - Fax:541-673-0925
Practice Address - Street 1:1729 W HARVARD AVE STE 3
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2795
Practice Address - Country:US
Practice Address - Phone:541-673-0924
Practice Address - Fax:541-673-0925
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics