Individual
DR. SHAN K BAGBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
450 GIBNER ROAD SUITE 2, CARLISE BARRACKS, PA 17013
(571) 231-5383
(502) 624-2966
Mailing address
9275 DOERR RD, BLDG 1221 STE 140, HQ, NORTHERN REGION DENTAL COMMAND (ATTN CREDENTIALS), FORT BELOIR, VA 22060-2205
(571) 231-5383
(502) 624-2966
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
20428
TX
Other
Enumeration date
05/26/2006
Last updated
06/30/2014
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