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General NPI Number Information
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NPI Number | 1740478064
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Entity Type | Organization
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Legal Business Name | SHANNON J DAUGHTRY DDS INC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 250 MAIN ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2351
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Country | US
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Telephone | 760-344-3262
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Fax | 760-344-1369
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Provider Business Mailing Address
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Address Line | 250 MAIN ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2351
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Country | US
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Telephone | 760-344-3262
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Fax | 760-344-1369
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. LEA DAUGHTRY
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Credential |
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Telephone | 760-344-3262
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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 | 42141
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License Number State | CA
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