Provider Demographics
NPI:1528028735
Name:ALLISON, SHANNON (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LAKE DORNOCH DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7169
Mailing Address - Country:US
Mailing Address - Phone:910-585-9021
Mailing Address - Fax:
Practice Address - Street 1:15 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-4343
Practice Address - Fax:910-295-3913
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice