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General NPI Number Information
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NPI Number | 1346966215
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Entity Type | Organization
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Legal Business Name | PERIODONTAL SPECIALISTS, PLLC
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 38 POND ST STE 207
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City | FRANKLIN
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State | MA
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Zip | 02038-3823
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Country | US
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Telephone | 508-520-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 76 SCHOOL ST
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City | HOPKINTON
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State | MA
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Zip | 01748-2167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. PATRICK CHARLES SHANNON
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Credential | DMD
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Telephone | 508-520-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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