Provider Demographics
NPI:1427013622
Name:PRESLEY-DICKENS, SHANNON DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DENISE
Last Name:PRESLEY-DICKENS
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 1:85 SOUTH WEST STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:23 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MORAVIA
Practice Address - State:NY
Practice Address - Zip Code:13118-3427
Practice Address - Country:US
Practice Address - Phone:607-344-0052
Practice Address - Fax:607-344-0056
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0584291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice