Provider Demographics
NPI:1962417733
Name:FRANK, SHAMAYNE MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAMAYNE
Middle Name:MARIA
Last Name:FRANK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:SHAMAYNE
Other - Middle Name:MARIA
Other - Last Name:DOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 W. 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4029
Mailing Address - Country:US
Mailing Address - Phone:712-252-9894
Mailing Address - Fax:712-252-9065
Practice Address - Street 1:321 W. 25TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4029
Practice Address - Country:US
Practice Address - Phone:712-252-9894
Practice Address - Fax:712-252-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082241223G0001X
NE64311223G0001X
SDM9991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962417733Medicaid
NE10025004500Medicaid
SD7809990Medicaid
IA0566224Medicaid
SD470924181Medicaid
SD470924181Medicaid