Provider Demographics
NPI:1891938932
Name:PASSINEAU, SHANNON W (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:W
Last Name:PASSINEAU
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 1:51 N. BALPH AVE.
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202
Mailing Address - Country:US
Mailing Address - Phone:724-584-5954
Mailing Address - Fax:
Practice Address - Street 1:51 N. BALPH AVE.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202
Practice Address - Country:US
Practice Address - Phone:412-761-1919
Practice Address - Fax:412-761-4383
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO37805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist