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General NPI Number Information
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NPI Number | 1760644132
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Entity Type | Individual
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Provider Name | THOMAS PATRICK SHANNON D.D.S., M.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 08/22/2015
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Provider Practice Location Address
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Address Line | 4320 44TH ST SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-2300
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Country | US
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Telephone | 616-534-0550
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Fax | 616-534-1334
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Provider Business Mailing Address
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Address Line | 4320 44TH ST SW NONE
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City | GRANDVILLE
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State | MI
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Zip | 49418-2300
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Country | US
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Telephone | 616-238-8387
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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 | 4469
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019565
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S47
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901019565
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License Number State | MI
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