Provider Demographics
NPI:1255427399
Name:DUFFY, SHANNON LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:DUFFY
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1961
Mailing Address - Country:US
Mailing Address - Phone:781-729-1900
Mailing Address - Fax:781-729-7102
Practice Address - Street 1:20 PONDMEADOW DR
Practice Address - Street 2:SUITE 202
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3218
Practice Address - Country:US
Practice Address - Phone:781-944-7799
Practice Address - Fax:781-944-1804
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA214961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics