Provider Demographics
NPI:1770151656
Name:VERCRUYSSE, SHAYNA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:MARIE
Last Name:VERCRUYSSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 280TH AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-4052
Mailing Address - Country:US
Mailing Address - Phone:507-828-3113
Mailing Address - Fax:
Practice Address - Street 1:108 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1508
Practice Address - Country:US
Practice Address - Phone:507-828-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist