Provider Demographics
NPI:1952856130
Name:MICHAEL E. SHANNON, D.M.D., P.S.C.
Entity Type:Organization
Organization Name:MICHAEL E. SHANNON, D.M.D., P.S.C.
Other - Org Name:SHANNON DENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-783-0824
Mailing Address - Street 1:800 N CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7118
Mailing Address - Country:US
Mailing Address - Phone:509-783-0824
Mailing Address - Fax:509-783-9136
Practice Address - Street 1:800 N CENTER PKWY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7118
Practice Address - Country:US
Practice Address - Phone:509-783-0824
Practice Address - Fax:509-783-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004797261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental