Provider Demographics
NPI:1023093788
Name:ARNDT, SHANNON NALLY (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NALLY
Last Name:ARNDT
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 1:4105 HARRY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1911
Mailing Address - Country:US
Mailing Address - Phone:361-334-6146
Mailing Address - Fax:
Practice Address - Street 1:327 CORAL SEA RD
Practice Address - Street 2:NAVAL HEALTH BRANCH CLINIC
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5001
Practice Address - Country:US
Practice Address - Phone:361-776-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice