Individual
BRYAN J SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
750 N KENDRICK ST STE 100, FLAGSTAFF, AZ 86001-3067
(928) 774-2500
Mailing address
750 N KENDRICK ST STE 100, FLAGSTAFF, AZ 86001-3067
(928) 774-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4241
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860783790
TAX ID
AZ
Enumeration date
11/16/2006
Last updated
03/22/2019
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