Individual
CAITLIN SUZANNE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2519 E MAIN ST STE 102, RICHMOND, IN 47374-5869
(765) 962-1519
Mailing address
4200 W COUNTY ROAD 100 S, NEW CASTLE, IN 47362-2578
(317) 617-8373
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013403A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2020
Last updated
06/26/2020
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