Dale Dawson Shahan, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021.000729 Issued in IL

Practice address

636 Hampshire St Ste 102
Quincy, IL 62301-3054

Phone

(217) 228-0101

Fax

(217) 222-7011

NPI assigned

Sep 21, 2009

Last updated

Sep 21, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dale D. Shahan DDS LTD

  • Dentist
  • Quincy, IL
  • NPI 1114234499
  Authorized official Same address or phone

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253491200000",
    "number": "1326372574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 HAMPSHIRE ST STE 102",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013054",
            "telephone_number": "217-228-0101",
            "fax_number": "217-222-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 HAMPSHIRE ST STE 102",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013054",
            "telephone_number": "217-228-0101",
            "fax_number": "217-222-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHAN",
        "first_name": "DALE",
        "middle_name": "DAWSON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-21",
        "last_updated": "2009-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.013067",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021.000729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Trey Sexton, LCSW
• Laurel Sexton, NP-C
• SH Care, LLC (Sycamore Healthcare Center)
• Kristin Shaffer, PT
• Ruchi Shah, MD
• Imran Shaikh, MD
• Shamim Amin Dental PLLC
• Shari Jones Physical Therapy Inc
• Mayank Sharma, M.D.
• Jason E. Sharp, MD

• Oral and Maxillofacial Surgery (Dentist) in Quincy, IL
• Providers in Quincy, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.