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Dr. Shane Russell William Pascoe , DMD

Dentist β€’ Hurlburt Field, FL

Active NPI 1417453077 Individual Practitioner Male Practitioner
Practice location in NPPES

113 Lielmanis Ave
Hurlburt Field, FL 325445613

Call 8508811020 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

113 Lielmanis Ave

Hurlburt Field, FL 325445613

Telephone 8508811020
Organization at the Same NPPES Address or Phone
1st Spcl Ops Medgrp-Hurlburt Facility NPI 1568442630

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Industry payments (Open Payments)

No Open Payments records are listed for this clinician for 2019–2025.

Guide: How to read an Open Payments record

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Hurlburt Field and Florida

7 active clinicians are listed under Dentist with a practice address in Hurlburt Field, FL (6,164 in Florida).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-08-27
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

License # reported to NPPES FL DN23525

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Dentist

NUCC Taxonomy Code: 122300000X

License # reported to NPPES FL 23525

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Florida Department of Health Medical Quality Assurance.
Look Up on State Board Site

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

3 listed
Dr. Matthew Edgar , DO

Emergency Medicine

NPI 1104356880

Doctor of Osteopathic Medicine (D.O.)

Dr. Don Vongviphut , DO

General Practice

NPI 1003356684

Doctor of Osteopathic Medicine (D.O.)

Laura Williams , APRN

Nurse Practitioner - Family

NPI 1710591185

Advanced Practice Registered Nurse

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

10 Historical Events
πŸ“
Updated Practice Location August 27, 2025

Registered at 113 LIELMANIS AVE, HURLBURT FIELD, FL 325445613 (Tel: 8508811020)

πŸ“
Updated Business Mailing Address August 27, 2025

Registered at 113 LIELMANIS AVE, HURLBURT FIELD, FL 325445613

πŸ“
Updated Practice Location June 20, 2018

Registered at 101 BODIN CIR, TRAVIS AFB, CA 94535 (Tel: 7074234300)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) June 20, 2018

Dentist (license number reported to NPPES: FL 23525)

βœ…
NPI Profile Active April 03, 2018

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) April 03, 2018

Registered at 124 HIBISCUS AVE, GULF BREEZE, FL 325614322 (Tel: 8502324013)

πŸ“
Business Mailing Address (Initial Record) April 03, 2018

Registered at 124 HIBISCUS AVE, GULF BREEZE, FL 325614322

πŸ‘€
Provider Name / Credentials (Initial Record) April 03, 2018

Recorded as SHANE PASCOE, DMD

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) April 03, 2018

Student in an Organized Health Care Education/Training Program

🟒
Initial NPI Registration & Enumeration April 03, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1417453077
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 03, 2018
Last Update: August 27, 2025
Sole Proprietor: No

Mailing Address

113 Lielmanis Ave

Hurlburt Field, FL 325445613

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.