Shannon Scott Obernuefemann, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D5408 Issued in AZ

Practice address

777 W Bethany Home Rd
Phoenix, AZ 85013-1651

Phone

(602) 242-1729

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1174530836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 W BETHANY HOME RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131651",
            "telephone_number": "602-242-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 W BETHANY HOME RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131651",
            "telephone_number": "602-242-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBERNUEFEMANN",
        "first_name": "SHANNON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esther O Oben
• Sharman Elizabeth Ober-Reynolds, MSN, FNP, CCRP
• Cynthia Faye Oberg, DMD
• David Armstrong Obergfell, LCSW
• Riley Kae Oberholtzer
• Marie E Oberst, D.O.
• Brianna R Obezo, RBT
• Ndidiamaka Uzoma Obiesie, MD
• Obifit
• Ifeoma Obiora, PHARMD

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.