Individual
DR. NIKOLAI JOHN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
260 N DETROIT ST, SUITE 2, XENIA, OH 45385-2268
(937) 372-7625
(937) 372-7626
Mailing address
260 N DETROIT ST, SUITE 2, XENIA, OH 45385-2268
(937) 372-7625
(937) 372-7626
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14469
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS6000020
BNDD FEDERAL NUMBER
OH
Enumeration date
05/08/2006
Last updated
07/08/2007
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