Organization
TIMOTHY P. SHANNON D.M.D., P.C.
Active
Other names
Johnson Creek Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY PATRICK SHANNON D.M.D. (PRESIDENT)
(503) 654-7773
Entity
Organization
Contact information
Practice address
4450 SE JOHNSON CREEK BLVD, MILWAUKIE, OR 97222-9217
(503) 654-7773
(503) 654-7774
Mailing address
4450 SE JOHNSON CREEK BLVD, MILWAUKIE, OR 97222-9217
(503) 654-7773
(503) 654-7774
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6975
OR
Other
Enumeration date
09/02/2006
Last updated
08/22/2020
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