Healthcare Provider Details

I. General information

NPI: 1295841757
Provider Name (Legal Business Name): SHANNON & HUNTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 TURNPIKE ST STE G-2
NORTH ANDOVOR MA
01845
US

IV. Provider business mailing address

203 TURNPIKE STREET SUITE G-2
NORTH ANDOVOR MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-5255
  • Fax: 978-682-0656
Mailing address:
  • Phone: 978-682-5255
  • Fax: 978-682-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL TIMOTHY SHANNON
Title or Position: ORAL & MAXILLOFACIAL SURGEON PRESID
Credential: DMD
Phone: 978-682-5255