Provider Demographics
NPI:1316164080
Name:BURL, SHAWN Y (DDS)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:Y
Last Name:BURL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:Y
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:139 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35204-4114
Mailing Address - Country:US
Mailing Address - Phone:205-254-8555
Mailing Address - Fax:205-254-8744
Practice Address - Street 1:139 3RD AVE W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-4114
Practice Address - Country:US
Practice Address - Phone:205-254-8555
Practice Address - Fax:205-254-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL195624OtherUNITED CONCORDIA
AL043851580OtherTAX ID
AL51517010OtherBLUE CROSS BLUE SHIELD
AL631263166OtherTAX ID