Basic Information
| Provider Information | |||||||||
| NPI: | 1336302272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHOTON | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD STOP 7500 | ||||||||
| Address2: | |||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615530 | ||||||||
| FaxNumber: | 9073614859 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD STOP 7500 | ||||||||
| Address2: | |||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615530 | ||||||||
| FaxNumber: | 9073614859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 1262 | AK | Y | Dental Providers | Dentist | General Practice |
No ID Information.