Provider Demographics
NPI:1508482183
Name:SHILO ANNIS DMD, PLLC
Entity Type:Organization
Organization Name:SHILO ANNIS DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-272-9847
Mailing Address - Street 1:5 MIDNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2376
Mailing Address - Country:US
Mailing Address - Phone:207-272-9847
Mailing Address - Fax:
Practice Address - Street 1:42 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1237
Practice Address - Country:US
Practice Address - Phone:207-647-3628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty