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General NPI Number Information
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NPI Number | 1538397179
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Entity Type | Individual
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Provider Name | SHANNON MICHAEL SENA DDS
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Gender | Male
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 1500 AVENUE F
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City | ELY
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State | NV
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Zip | 89301-3506
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Country | US
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Telephone | 775-289-3375
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 150575
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City | ELY
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State | NV
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Zip | 89315-0575
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Country | US
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Telephone | 775-354-6627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5934
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License Number State | NV
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