Provider Demographics
NPI:1285986067
Name:SHORES, TANYA LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LYNN
Last Name:SHORES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 GEORE C. WILSON DR.
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4501
Mailing Address - Country:US
Mailing Address - Phone:706-855-8818
Mailing Address - Fax:706-855-0534
Practice Address - Street 1:1210 GEORE C. WILSON DR.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4501
Practice Address - Country:US
Practice Address - Phone:706-855-8818
Practice Address - Fax:706-855-0534
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014451122300000X
SC8118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist