Provider Demographics
NPI:1134565328
Name:HYLIND, SHANNON REVELEY (DDS)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:REVELEY
Last Name:HYLIND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:KELIHER
Other - Last Name:REVELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:43 JONES FALLS TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1684
Mailing Address - Country:US
Mailing Address - Phone:443-622-9276
Mailing Address - Fax:
Practice Address - Street 1:8241 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2842
Practice Address - Country:US
Practice Address - Phone:410-687-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist