Provider Demographics
NPI:1043434996
Name:SHINABERY, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHINABERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 OKLAHOMA RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6620
Mailing Address - Country:US
Mailing Address - Phone:410-795-0101
Mailing Address - Fax:410-795-0765
Practice Address - Street 1:6351 OKLAHOMA RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6620
Practice Address - Country:US
Practice Address - Phone:410-795-0101
Practice Address - Fax:410-795-0765
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice