Provider Demographics
NPI:1235540345
Name:CHAPMAN, SHANNON (DDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CHAPMAN
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 1:250 AMERICAN WAY
Mailing Address - Street 2:APT. 604
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-4502
Mailing Address - Country:US
Mailing Address - Phone:443-756-8484
Mailing Address - Fax:
Practice Address - Street 1:250 AMERICAN WAY
Practice Address - Street 2:APT. 604
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-4502
Practice Address - Country:US
Practice Address - Phone:443-756-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10015111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice