Provider Demographics
NPI:1407013550
Name:CAMPBELL, SHANNON MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:CAMPBELL
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 1:31450 W SEVEN MILE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1375
Mailing Address - Country:US
Mailing Address - Phone:248-474-8100
Mailing Address - Fax:248-888-9593
Practice Address - Street 1:31450 W SEVEN MILE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1375
Practice Address - Country:US
Practice Address - Phone:248-474-8100
Practice Address - Fax:248-888-9593
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist