Provider Demographics
NPI:1760819197
Name:WASHINGTON, SHAWNTAE MARIE (DENTAL ASST)
Entity type:Individual
Prefix:
First Name:SHAWNTAE
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DENTAL ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38633 10TH ST E APT 226
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-3827
Mailing Address - Country:US
Mailing Address - Phone:661-450-7016
Mailing Address - Fax:
Practice Address - Street 1:38633 10TH STREET EAST
Practice Address - Street 2:226
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-450-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant