Basic Information
| Provider Information | |||||||||
| NPI: | 1760571103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAY | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 WILLIAMSBURG DR | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630191271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174507535 | ||||||||
| FaxNumber: | 6182129054 | ||||||||
| Practice Location | |||||||||
| Address1: | 6407 N ILLINOIS ST | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622082720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183100263 | ||||||||
| FaxNumber: | 6182129054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 019027153 | IL | Y | Dental Providers | Dentist | 1223G0001X | 2018028936 | MO | N | Dental Providers | Dentist | General Practice |
No ID Information.