Provider Demographics
NPI:1447884770
Name:TURGEON, SHANE MITCHELL (DMD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MITCHELL
Last Name:TURGEON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 4TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-2401
Mailing Address - Country:US
Mailing Address - Phone:612-747-3514
Mailing Address - Fax:
Practice Address - Street 1:101 4TH AVE STE D
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-2401
Practice Address - Country:US
Practice Address - Phone:850-683-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist