Provider Demographics
NPI:1285759043
Name:SHATTUCK, DELYNN M (DDS)
Entity type:Individual
Prefix:DR
First Name:DELYNN
Middle Name:M
Last Name:SHATTUCK
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 1:8411 CIRCLEWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-8529
Mailing Address - Country:US
Mailing Address - Phone:989-781-1178
Mailing Address - Fax:
Practice Address - Street 1:5382 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6035
Practice Address - Country:US
Practice Address - Phone:989-790-3400
Practice Address - Fax:989-790-4923
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0135081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice