Provider Demographics
NPI:1922613272
Name:HAHN, SHANNON RAE (EPDH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:HAHN
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 SW OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8432
Mailing Address - Country:US
Mailing Address - Phone:937-303-3471
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 228
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1803
Practice Address - Country:US
Practice Address - Phone:503-587-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8080124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist