Individual
SHANNONJ LEE FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
3155 W INDIAN SCHOOL RD, PHOENIX, AZ 85017-4035
(602) 212-9533
Mailing address
3530 E MORELAND ST APT 3, PHOENIX, AZ 85008-5247
(480) 430-1172
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
31911
CA
Other
Enumeration date
05/21/2007
Last updated
07/09/2007
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