Provider Demographics
NPI:1508183450
Name:MAGNUSON, SHANNON I (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:I
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10121 N NEVADA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3120
Mailing Address - Country:US
Mailing Address - Phone:509-443-5597
Mailing Address - Fax:509-863-9701
Practice Address - Street 1:10121 N NEVADA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3120
Practice Address - Country:US
Practice Address - Phone:509-443-5597
Practice Address - Fax:509-863-9701
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA76281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics