Individual
SHANON BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
316 N MAIN ST STE 1, STILLWATER, OK 74075-5548
(405) 372-7474
Mailing address
1208 S DUNCAN ST, STILLWATER, OK 74074-4427
(785) 766-8786
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7631
OK
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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