Provider Demographics
NPI:1235510967
Name:SHAUGHNESSY, MATTHEW BERNARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BERNARD
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2647
Mailing Address - Country:US
Mailing Address - Phone:708-362-2594
Mailing Address - Fax:
Practice Address - Street 1:2962 STATE ROUTE 39
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8852
Practice Address - Country:US
Practice Address - Phone:330-893-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033443122300000X
OH30.248911223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program