Provider Demographics
NPI:1891945333
Name:ANKENBRANDT, SHANNON WILLIAMS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:WILLIAMS
Last Name:ANKENBRANDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 WOLFRUM RD
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7625
Mailing Address - Country:US
Mailing Address - Phone:636-300-4545
Mailing Address - Fax:636-329-0244
Practice Address - Street 1:1041 WOLFRUM RD
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-7625
Practice Address - Country:US
Practice Address - Phone:636-300-4545
Practice Address - Fax:636-329-0244
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist