Provider Demographics
NPI:1710765128
Name:MCDONALD, SHANNON (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 INLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2227
Mailing Address - Country:US
Mailing Address - Phone:412-725-4373
Mailing Address - Fax:
Practice Address - Street 1:4409 INLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2227
Practice Address - Country:US
Practice Address - Phone:412-725-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068177124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist