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NPI Code Detail

MEDICARE: DR. MICHAEL A. SHANNON D.D.S., M.S.

MEDICARE: DR. MICHAEL A. SHANNON D.D.S., M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry54956CA

General Provider Information

NPI Number : 1316168693
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL A. SHANNON D.D.S., M.S.
Provider Business Mailing Address
First Line : 206 CALLE POTRANCA
Second Line :
City : SAN CLEMENTE
State : CA
Zip : 92672-4552
Country : US
Telephone Number : 949-573-5654
Fax Number :
Provider Business Practice Location Address
First Line : 1601 MILL ROCK WAY
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93311-1315
Country : US
Telephone Number : 949-573-5654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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