Provider Demographics
NPI:1417032756
Name:PYE, SHANNON MORRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MORRIS
Last Name:PYE
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0005
Mailing Address - Country:US
Mailing Address - Phone:843-549-5913
Mailing Address - Fax:843-549-5193
Practice Address - Street 1:664 HIERS CORNER RD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2897
Practice Address - Country:US
Practice Address - Phone:843-549-5913
Practice Address - Fax:843-549-5193
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9652Medicaid
SCZX3282Medicaid