MEDICARE: DR. SHANNON GUIRE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN15713	FL
2	122300000X	Dentist	DI02405200	NJ

General Provider Information

NPI Number	:	1093793002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON GUIRE DMD

Provider Business Mailing Address
First Line	:	23659 COLUMBUS RD
Second Line	:	SUITE #1
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1980
Country	:	US
Telephone Number	:	609-298-5800
Fax Number	:	609-298-6895

Provider Business Practice Location Address
First Line	:	23659 COLUMBUS RD
Second Line	:	SUITE #1
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1980
Country	:	US
Telephone Number	:	609-298-5800
Fax Number	:	609-298-6895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	06/21/2010

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