Provider Demographics
NPI:1831714328
Name:MOREY, SHANNON THERESA (DMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:THERESA
Last Name:MOREY
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 1:445 E MOSSYLEAF DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-4072
Mailing Address - Country:US
Mailing Address - Phone:256-698-2717
Mailing Address - Fax:
Practice Address - Street 1:10871 COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3668
Practice Address - Country:US
Practice Address - Phone:256-724-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006764-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice