Individual
DR. KEN SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
3434 VILLA LN, SUITE 110, NAPA, CA 94558-6405
(707) 255-0555
(707) 255-8172
Mailing address
3434 VILLA LN, SUITE 110, NAPA, CA 94558-6405
(707) 255-0555
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
57940
CA
Other
Enumeration date
10/11/2011
Last updated
02/13/2012
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