Individual
SHANNON RACHEL FAXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 MOUNT HUNGER SHORE RD, WINDHAM, ME 04062-5636
(207) 831-6704
Mailing address
120 MOUNT HUNGER SHORE RD, WINDHAM, ME 04062-5636
(207) 831-6704
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH2965
ME
Other
Enumeration date
03/08/2019
Last updated
03/08/2019
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