Healthcare Provider Details

I. General information

NPI: 1750959607
Provider Name (Legal Business Name): SHANNON BISCHOFF DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 04/15/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7518 ELBOW BEND RD
CAREFREE AZ
85377
US

IV. Provider business mailing address

7557 N DREAMY DRAW DR UNIT 145
PHOENIX AZ
85020-4653
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9735
  • Fax:
Mailing address:
  • Phone: 765-698-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011114
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: