Healthcare Provider Details

I. General information

NPI: 1306649215
Provider Name (Legal Business Name): SHANNON NOROOZI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUSSEX AVE
MILFORD DE
19963-1853
US

IV. Provider business mailing address

3 SUSSEX AVE
MILFORD DE
19963-1853
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-9637
  • Fax:
Mailing address:
  • Phone: 302-422-9637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0011655
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: