Provider Demographics
NPI:1710141924
Name:SHANNA LURIE DDS PA
Entity Type:Organization
Organization Name:SHANNA LURIE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-819-1254
Mailing Address - Street 1:5162 LINTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6567
Mailing Address - Country:US
Mailing Address - Phone:561-819-1254
Mailing Address - Fax:561-819-6978
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-819-1254
Practice Address - Fax:561-819-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15042261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental