Provider Demographics
NPI:1720397342
Name:SPALDING, SHANNON JOY MCGRANE (DMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JOY MCGRANE
Last Name:SPALDING
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:PO BOX 196320
Mailing Address - Street 2:ANMC DENTAL DEPARTMENT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-6320
Mailing Address - Country:US
Mailing Address - Phone:907-317-6070
Mailing Address - Fax:806-794-1919
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-317-6070
Practice Address - Fax:806-794-1919
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist