# SHANNON WILSON DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710794979
- **Authorized official:** DR. SHANNON WILSON DDS (OWNER)
- **Authorized official phone:** (206) 920-5430

## Contact information

- **Practice address:** 11730 15TH AVE NE, SEATTLE, WA 98125-5026
- **Practice address phone:** (206) 920-5430
- **Mailing address:** 18529 LINDEN AVE N, SHORELINE, WA 98133-3926
- **Mailing address phone:** (206) 920-5430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/11/2024
- **Last updated:** 12/11/2024