Healthcare Provider Details

I. General information

NPI: 1962728733
Provider Name (Legal Business Name): SHANNON O DOYLE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N HIGHWAY 190 STE 1
COVINGTON LA
70433-9061
US

IV. Provider business mailing address

2301 N HIGHWAY 190 STE 1
COVINGTON LA
70433-9061
US

V. Phone/Fax

Practice location:
  • Phone: 985-302-0492
  • Fax: 985-302-0493
Mailing address:
  • Phone: 985-302-0492
  • Fax: 985-302-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: