Provider Demographics
NPI:1548771512
Name:SHANLEY AND ONG PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SHANLEY AND ONG PEDIATRIC DENTISTRY
Other - Org Name:SUNSHINE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-622-7786
Mailing Address - Street 1:409 PRESCOT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5086
Mailing Address - Country:US
Mailing Address - Phone:215-622-7786
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLANDS DR STE 304
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7692
Practice Address - Country:US
Practice Address - Phone:717-626-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629338199OtherYING-LEE ONG
1154635837OtherBRIANNE SHANLEY