Healthcare Provider Details

I. General information

NPI: 1134279748
Provider Name (Legal Business Name): SHANNON RODRIGUES ESPINOLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 PLEASANT ST
FALL RIVER MA
02723-1718
US

IV. Provider business mailing address

1395 PLEASANT ST
FALL RIVER MA
02723-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-8984
  • Fax: 508-672-4239
Mailing address:
  • Phone: 508-672-8984
  • Fax: 508-672-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: