Individual
DR. SHANNON HARRIS WAILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
605 ESTHER WAY, REDLANDS, CA 92373-5821
(760) 716-5280
Mailing address
605 ESTHER WAY, REDLANDS, CA 92373-5821
(760) 716-5280
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DDS110012
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/26/2019
Last updated
08/06/2024
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