Provider Demographics
NPI:1891151072
Name:AGNIESZKA E SHANAHAN, DMD, PC
Entity Type:Organization
Organization Name:AGNIESZKA E SHANAHAN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:774-239-7205
Mailing Address - Street 1:239 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1740
Mailing Address - Country:US
Mailing Address - Phone:508-885-6956
Mailing Address - Fax:508-885-2025
Practice Address - Street 1:239 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1740
Practice Address - Country:US
Practice Address - Phone:508-885-6956
Practice Address - Fax:508-885-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855392261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental