Provider Demographics
NPI:1093793002
Name:GUIRE, SHANNON (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:GUIRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23659 COLUMBUS RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1980
Mailing Address - Country:US
Mailing Address - Phone:609-298-5800
Mailing Address - Fax:609-298-6895
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE #1
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1980
Practice Address - Country:US
Practice Address - Phone:609-298-5800
Practice Address - Fax:609-298-6895
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157131223G0001X
NJDI02405200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice