Individual
DR. SHAWN C COUNTRYMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
(719) 335-9886
Mailing address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
N-9870
ID
1223X0008X
Oral and Maxillofacial Radiology Dentistry
00205167
CO
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
N-9870
ID
390200000X
Student in an Organized Health Care Education/Training Program
30418
IA
Other
Enumeration date
08/17/2011
Last updated
08/17/2022
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