Provider Demographics
NPI:1033311717
Name:ANDERSON, SHAUNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:LYNN
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9800 SHELARD PKWY
Mailing Address - Street 2:SUITE #130
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6411
Mailing Address - Country:US
Mailing Address - Phone:763-525-5011
Mailing Address - Fax:763-525-8943
Practice Address - Street 1:9800 SHELARD PKWY
Practice Address - Street 2:SUITE #130
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6411
Practice Address - Country:US
Practice Address - Phone:763-525-5011
Practice Address - Fax:763-525-8943
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice