Provider Demographics
NPI:1225180193
Name:SHANER, WILLIAM G (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:SHANER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:G
Other - Last Name:SHANER DDS, MS, PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
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:171-599-5107
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:171-599-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics