Provider Demographics
NPI:1568577377
Name:MESSER, SHANNON MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARK
Last Name:MESSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 TEXAS AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2808
Mailing Address - Country:US
Mailing Address - Phone:409-735-8146
Mailing Address - Fax:409-735-2167
Practice Address - Street 1:1860 TEXAS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2808
Practice Address - Country:US
Practice Address - Phone:409-735-8146
Practice Address - Fax:409-735-2167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice