Provider Demographics
NPI:1114182938
Name:SHAMMO, JOHNNY (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:SHAMMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 EXETER ST APT F
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3050
Mailing Address - Country:US
Mailing Address - Phone:909-583-4224
Mailing Address - Fax:
Practice Address - Street 1:11261 EXETER ST APT F
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3050
Practice Address - Country:US
Practice Address - Phone:909-583-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice