Healthcare Provider Details

I. General information

NPI: 1891188868
Provider Name (Legal Business Name): AMY SHANNON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 03/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MANCHESTER ST SUITE #5
CONCORD NH
03301-5142
US

IV. Provider business mailing address

153 MANCHESTER ST SUITE #5
CONCORD NH
03301-5142
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number02356
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: