Provider Demographics
NPI:1164883070
Name:MUNSIE, SHANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:MUNSIE
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:CHILDREN'S HOSPITAL OF EASTERN ONTARIO, 401 SMYTH ROAD
Mailing Address - Street 2:DENTAL CLINIC (C7)
Mailing Address - City:OTTAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K1N 1J6
Mailing Address - Country:CA
Mailing Address - Phone:613-737-2616
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL OF EASTERN ONTARIO, 401 SMYTH ROAD
Practice Address - Street 2:DENTAL CLINIC (C7)
Practice Address - City:OTTAWA
Practice Address - State:ONTARIO
Practice Address - Zip Code:K1N 1J6
Practice Address - Country:CA
Practice Address - Phone:613-737-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ101095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist