MEDICARE: DR. SHANNON ANDREWS KITTRELL DDS

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
1	122300000X	Dentist	0401416170	VA

General Provider Information

NPI Number	:	1437635331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON ANDREWS KITTRELL DDS

Provider Business Mailing Address
First Line	:	8804 PATTERSON AVE STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-6361
Country	:	US
Telephone Number	:	804-740-7212
Fax Number	:	804-741-6009

Provider Business Practice Location Address
First Line	:	8804 PATTERSON AVE STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-6361
Country	:	US
Telephone Number	:	804-740-7212
Fax Number	:	804-741-6009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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