Provider Demographics
NPI:1356918874
Name:DUGAN, SHANNON MICHAELA (DMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHAELA
Last Name:DUGAN
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 1:3524 COUNTRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1065
Mailing Address - Country:US
Mailing Address - Phone:412-580-1629
Mailing Address - Fax:
Practice Address - Street 1:563 EPSILON DR STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2830
Practice Address - Country:US
Practice Address - Phone:124-490-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859078122300000X, 390200000X
390200000X
PADS0442031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program