Provider Demographics
NPI:1932889995
Name:SHANNON, EILEEN KAY (DDS)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:KAY
Last Name:SHANNON
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 1:901 FARNAM ST APT 433
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-5055
Mailing Address - Country:US
Mailing Address - Phone:929-777-0492
Mailing Address - Fax:
Practice Address - Street 1:901 FARNAM ST APT 433
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-5055
Practice Address - Country:US
Practice Address - Phone:929-777-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist