Provider Demographics
NPI:1528419728
Name:DUQUM, SHANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:DUQUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:OSWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1481
Mailing Address - Country:US
Mailing Address - Phone:440-466-4884
Mailing Address - Fax:
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1481
Practice Address - Country:US
Practice Address - Phone:440-466-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist