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Individual

DR. ROBERT EDWARD SHANNON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
754 WILSON STREET EXTENSION, CHESTER, SC 29706-0840
(803) 377-1997
(803) 581-7332
Mailing address
PO BOX 840, CHESTER, SC 29706-0840
(803) 377-1997
(803) 581-7332

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1505
SC

Other

Enumeration date
02/07/2007
Last updated
07/08/2007
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