Individual
JAYDE D SHANNON,
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IPH
Contact information
Practice address
50 SUMMER ST, MILLINOCKET, ME 04462-1400
(207) 528-2285
(207) 528-2880
Mailing address
PO BOX 500, PATTEN, ME 04765-0500
(207) 528-2285
(207) 528-2880
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
IPH97
ME
Other
Enumeration date
08/12/2011
Last updated
09/02/2016
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