Individual
MICHAEL E SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
800 N CENTER PKWY, KENNEWICK, WA 99336-7118
(509) 783-0824
(509) 783-9136
Mailing address
800 N CENTER PKWY, KENNEWICK, WA 99336-7118
(509) 783-0824
(509) 783-9136
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00004797
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE00004797
STATE DENTAL LICENSE
WA
Enumeration date
10/13/2006
Last updated
07/08/2007
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