Individual
DR. JACK A SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
601 S 124TH ST. WEST, TAFT, OK 74463
(918) 682-7841
(918) 682-6107
Mailing address
9807 S 225TH EAST AVE, BROKEN ARROW, OK 74014-5928
(918) 519-5751
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5531
OK
Other
Enumeration date
01/07/2011
Last updated
01/07/2011
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