Provider Demographics
NPI:1598939910
Name:SHANNON NORMAN-KOTRE, DDS, PLLC
Entity Type:Organization
Organization Name:SHANNON NORMAN-KOTRE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBEJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-677-2156
Mailing Address - Street 1:2240 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5151
Mailing Address - Country:US
Mailing Address - Phone:734-677-2156
Mailing Address - Fax:734-677-2638
Practice Address - Street 1:2240 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5151
Practice Address - Country:US
Practice Address - Phone:734-677-2156
Practice Address - Fax:734-677-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty