Provider Demographics
NPI:1306115647
Name:SHAHEEN, EDWARD J JR (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:SHAHEEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10363 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2907
Mailing Address - Country:US
Mailing Address - Phone:314-991-0697
Mailing Address - Fax:314-991-3436
Practice Address - Street 1:10363 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2907
Practice Address - Country:US
Practice Address - Phone:314-991-0697
Practice Address - Fax:314-991-3436
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0124281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics