Individual
TIMOTHY PATRICK SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4450 SE JOHNSON CREEK BLVD, MILWAUKIE, OR 97222-9217
(503) 654-7773
(503) 654-7774
Mailing address
7524 SE 31ST AVE, PORTLAND, OR 97202-8533
(503) 771-1106
(503) 654-7774
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6975
OR
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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