Provider Demographics
NPI:1093867905
Name:WILLIAM G. SHANER DDS, MS, PC.
Entity Type:Organization
Organization Name:WILLIAM G. SHANER DDS, MS, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:1719-599-5107
Mailing Address - Street 1:2575 MONTEBELLO DR W STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6959
Mailing Address - Country:US
Mailing Address - Phone:171-959-9510
Mailing Address - Fax:
Practice Address - Street 1:2575 MONTEBELLO DR W STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6959
Practice Address - Country:US
Practice Address - Phone:171-959-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty