Healthcare Provider Details

I. General information

NPI: 1497900914
Provider Name (Legal Business Name): SHANNON MARA COEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON MARA COEN KOENIG D.M.D.

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16080 N 59TH AVE SUITE A
GLENDALE AZ
85306-2339
US

IV. Provider business mailing address

16080 N. 59TH AVENUE SUITE A
GLENDALE AZ
85306-2339
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-1100
  • Fax: 602-419-2244
Mailing address:
  • Phone: 602-978-1100
  • Fax: 602-419-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7588
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: