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General NPI Number Information
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NPI Number | 1639080088
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Entity Type | Individual
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Provider Name | SHANNON WILSON RDH
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Gender | Female
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 925 MAIN ST STE C
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City | BROOMFIELD
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State | CO
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Zip | 80020-1976
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Country | US
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Telephone | 303-469-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 3909 W 99TH PL
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City | WESTMINSTER
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State | CO
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Zip | 80031-2645
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Country | US
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Telephone | 307-690-8725
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.000906327
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License Number State | CO
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