Provider Demographics
NPI:1437635331
Name:KITTRELL, SHANNON ANDREWS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ANDREWS
Last Name:KITTRELL
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 1:8804 PATTERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6361
Mailing Address - Country:US
Mailing Address - Phone:804-740-7212
Mailing Address - Fax:804-741-6009
Practice Address - Street 1:8804 PATTERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6361
Practice Address - Country:US
Practice Address - Phone:804-740-7212
Practice Address - Fax:804-741-6009
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist