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General NPI Number Information
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NPI Number | 1750443545
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Entity Type | Individual
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Provider Name | SHANEE EDMONDS DDS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 8101 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-5059
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Country | US
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Telephone | 216-229-7440
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 SHANNON RD
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City | CLEVELAND HTS
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State | OH
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Zip | 44118-1933
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Country | US
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Telephone | 615-522-7695
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8430
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-023115
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License Number State | OH
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