Provider Demographics
NPI:1447454954
Name:VERSCHUEREN, DAVID SHANE (DMD, MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHANE
Last Name:VERSCHUEREN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SE 117TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5297
Mailing Address - Country:US
Mailing Address - Phone:360-695-4300
Mailing Address - Fax:360-695-4344
Practice Address - Street 1:601 SE 117TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5297
Practice Address - Country:US
Practice Address - Phone:360-695-4300
Practice Address - Fax:360-695-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60071474204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery