Provider Demographics
NPI:1831453869
Name:SHATTUCK, WILLIAM DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DEAN
Last Name:SHATTUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14208 TIJUANA TRL
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4894
Mailing Address - Country:US
Mailing Address - Phone:214-934-9287
Mailing Address - Fax:
Practice Address - Street 1:295 FM 156 S.
Practice Address - Street 2:SUITE 200
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052
Practice Address - Country:US
Practice Address - Phone:817-439-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6430122300000X
TX31589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist