Provider Demographics
NPI:1093129280
Name:CARPS, SHANNON (DDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CARPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3360
Mailing Address - Country:US
Mailing Address - Phone:330-666-6111
Mailing Address - Fax:
Practice Address - Street 1:525 N CLEVELAND MASSILLON RD
Practice Address - Street 2:SUITE #105
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3360
Practice Address - Country:US
Practice Address - Phone:330-666-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024175125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist