Provider Demographics
NPI:1235581125
Name:STRONG, SHANICE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANICE
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHANICE
Other - Middle Name:
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6480 HONEY GRV APT 203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-9534
Mailing Address - Country:US
Mailing Address - Phone:860-502-4996
Mailing Address - Fax:
Practice Address - Street 1:5430 TUTT BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2515
Practice Address - Country:US
Practice Address - Phone:719-380-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN220211223G0001X
CODEN.002042571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice