Provider Demographics
NPI:1528026440
Name:SAVAGE-CERNA, SHANNON LUCILLE (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LUCILLE
Last Name:SAVAGE-CERNA
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13903 LAURELBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1589
Mailing Address - Country:US
Mailing Address - Phone:210-732-8880
Mailing Address - Fax:210-732-5598
Practice Address - Street 1:1123 BABCOCK RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-6917
Practice Address - Country:US
Practice Address - Phone:210-732-8880
Practice Address - Fax:210-732-5598
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD171151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice