Provider Demographics
NPI:1497838288
Name:THOMAS, SHANNON R (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 GOLDEN SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-231-0077
Mailing Address - Fax:256-231-0866
Practice Address - Street 1:1715 GOLDEN SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-231-0077
Practice Address - Fax:256-231-0866
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 47361223P0300X
ALAL47361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics