Dr. Shane Russell William Pascoe, DMD
Dentist in Hurlburt Field, FL. Individual provider (NPI-1).
NPI number1417453077
StatusActive
Last updated in NPPESAug 27, 2025
Details
- NPI
- 1417453077
- Entity type
- Individual (NPI-1)
- Name
- Dr. Shane Russell William Pascoe
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 3, 2018
- Certification date
- Aug 27, 2025
- Last updated
- Aug 27, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DN23525 | FL | Yes |
| 122300000X | Dentist | 23525 | FL | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
113 Lielmanis AveHurlburt Field, FL 32544-5613
Phone 850-881-1020
Mailing address
113 Lielmanis AveHurlburt Field, FL 32544-5613
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 7 Dentist providers in Hurlburt Field · All 284 providers in Hurlburt Field
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