Provider Demographics
NPI:1144374984
Name:HOWARD E SHAYNE DDS AND MARY LYNN SHAYNE DDS PC
Entity type:Organization
Organization Name:HOWARD E SHAYNE DDS AND MARY LYNN SHAYNE DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-882-3335
Mailing Address - Street 1:3250 E. BATTLEFIELD RD.
Mailing Address - Street 2:SUITE S
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4051
Mailing Address - Country:US
Mailing Address - Phone:417-882-3335
Mailing Address - Fax:417-882-3435
Practice Address - Street 1:3250 E. BATTLEFIELD RD.
Practice Address - Street 2:SUITE S
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4051
Practice Address - Country:US
Practice Address - Phone:417-882-3335
Practice Address - Fax:417-882-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty