1952856130 NPI number — MICHAEL E. SHANNON, D.M.D., P.S.C.

Table of content: (NPI 1952856130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952856130 NPI number — MICHAEL E. SHANNON, D.M.D., P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL E. SHANNON, D.M.D., P.S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHANNON DENTAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952856130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 N CENTER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-7118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-783-0824
Provider Business Mailing Address Fax Number:
509-783-9136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-0824
Provider Business Practice Location Address Fax Number:
509-783-9136
Provider Enumeration Date:
08/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHANNON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-783-0824

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DE00004797 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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