Provider Demographics
NPI:1134294200
Name:SHANNON STAPP DDS PA
Entity Type:Organization
Organization Name:SHANNON STAPP DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:POULAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-331-7827
Mailing Address - Street 1:3420 THORNTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3928
Mailing Address - Country:US
Mailing Address - Phone:806-331-7827
Mailing Address - Fax:806-331-0948
Practice Address - Street 1:3420 THORNTON DRIVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3928
Practice Address - Country:US
Practice Address - Phone:806-331-7827
Practice Address - Fax:806-331-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty