Provider Demographics
NPI:1235668179
Name:ANNIS, SHILO (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHILO
Middle Name:
Last Name:ANNIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MILT BROWN RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6391
Mailing Address - Country:US
Mailing Address - Phone:207-272-9847
Mailing Address - Fax:
Practice Address - Street 1:42 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1237
Practice Address - Country:US
Practice Address - Phone:207-647-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist