Provider Demographics
NPI:1508092826
Name:ANDERSON, SHANEAN MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANEAN
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S FRANKLIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2799
Mailing Address - Country:US
Mailing Address - Phone:919-825-1795
Mailing Address - Fax:919-229-8483
Practice Address - Street 1:900 S FRANKLIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2799
Practice Address - Country:US
Practice Address - Phone:919-825-1795
Practice Address - Fax:919-229-8483
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist