Provider Demographics
NPI:1689821324
Name:STAPP, SHANNON D (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:D
Last Name:STAPP
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 1:3420 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3928
Mailing Address - Country:US
Mailing Address - Phone:806-331-7827
Mailing Address - Fax:
Practice Address - Street 1:3420 THORNTON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3928
Practice Address - Country:US
Practice Address - Phone:806-331-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134294200OtherORGANIZATION