Provider Demographics
NPI:1295743458
Name:GRASER, SHAUN DOUGLASS (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:DOUGLASS
Last Name:GRASER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 NOKOMIS AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-485-1191
Mailing Address - Fax:941-485-1643
Practice Address - Street 1:321 NOKOMIS AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-485-1191
Practice Address - Fax:941-485-1643
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T94150Medicare UPIN