Provider Demographics
NPI:1851490585
Name:SHANNON, DANIEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:SHANNON
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 1:1650 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1192
Mailing Address - Country:US
Mailing Address - Phone:651-777-7372
Mailing Address - Fax:651-777-5293
Practice Address - Street 1:1650 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1192
Practice Address - Country:US
Practice Address - Phone:651-777-7372
Practice Address - Fax:651-777-5293
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice