Provider Demographics
NPI:1154708931
Name:POUGHER, SHYENNE (DDS)
Entity type:Individual
Prefix:
First Name:SHYENNE
Middle Name:
Last Name:POUGHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1059
Mailing Address - Country:US
Mailing Address - Phone:607-776-6600
Mailing Address - Fax:
Practice Address - Street 1:355 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1059
Practice Address - Country:US
Practice Address - Phone:607-776-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0586271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice