Provider Demographics
NPI:1104029883
Name:CESTARI, SHANNON COYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:COYLE
Last Name:CESTARI
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 1:1000 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3149
Mailing Address - Country:US
Mailing Address - Phone:817-261-3100
Mailing Address - Fax:817-303-3715
Practice Address - Street 1:1000 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3149
Practice Address - Country:US
Practice Address - Phone:817-261-3100
Practice Address - Fax:817-303-3715
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1901290Medicaid