Provider Demographics
NPI:1457465544
Name:SHANNON, WILLIAM FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:SHANNON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 OAKLAND AVENUE
Mailing Address - Street 2:MERCY MEDICAL PLAZA BLDG A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-354-3500
Mailing Address - Fax:740-353-0818
Practice Address - Street 1:1835 OAKLAND AVENUE
Practice Address - Street 2:MERCY MEDICAL PLAZA BLDG A
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-354-3500
Practice Address - Fax:740-353-0818
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250973Medicaid