Individual
DR. SHANNON VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
9706 TAYLORSVILLE RD, LOUISVILLE, KY 40299-2753
(502) 267-0546
(502) 267-7306
Mailing address
9706 TAYLORSVILLE RD, LOUISVILLE, KY 40299-2753
(502) 438-5387
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5165
AL
1223G0001X
General Practice Dentistry
5165
AL
1223G0001X
General Practice Dentistry
Primary
9092
KY
Other
Enumeration date
08/18/2006
Last updated
03/22/2016
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