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General NPI Number Information
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NPI Number | 1134294200
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Entity Type | Organization
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Legal Business Name | SHANNON STAPP DDS PA
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 3420 THORNTON DRIVE
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City | AMARILLO
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State | TX
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Zip | 79109-3928
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Country | US
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Telephone | 806-331-7827
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Fax | 806-331-0948
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Provider Business Mailing Address
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Address Line | 3420 THORNTON DRIVE
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City | AMARILLO
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State | TX
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Zip | 79109-3928
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Country | US
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Telephone | 806-331-7827
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Fax | 806-331-0948
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LIZ A POULAIN
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Credential |
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Telephone | 806-331-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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