Provider Demographics
NPI:1760498117
Name:SHAHAN, MICHAEL HALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HALL
Last Name:SHAHAN
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 1:2000 DUDLEY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3476
Mailing Address - Country:US
Mailing Address - Phone:304-422-8400
Mailing Address - Fax:
Practice Address - Street 1:2000 DUDLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3476
Practice Address - Country:US
Practice Address - Phone:304-422-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics