Healthcare Provider Details

I. General information

NPI: 1225174592
Provider Name (Legal Business Name): SHANNON M. PARRIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 WISTERIA DR SUITE # 300
SNELLVILLE GA
30078-4606
US

IV. Provider business mailing address

2220 WISTERIA DR SUITE # 300
SNELLVILLE GA
30078-4606
US

V. Phone/Fax

Practice location:
  • Phone: 770-449-0836
  • Fax:
Mailing address:
  • Phone: 770-449-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number012120
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: