Provider Demographics
NPI:1659065753
Name:BLAND, SHANNON (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:BLAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 MANASTASH RD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-7830
Mailing Address - Country:US
Mailing Address - Phone:509-899-0491
Mailing Address - Fax:
Practice Address - Street 1:2401 W DOLARWAY RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-9309
Practice Address - Country:US
Practice Address - Phone:509-925-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614307521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice