MEDICARE: DR. SHANNON G PARSONS DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6922	NC

General Provider Information

NPI Number	:	1447339700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON G PARSONS DMD

Provider Business Mailing Address
First Line	:	7751 BALLANTYNE COMMONS PKWY
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2442
Country	:	US
Telephone Number	:	704-544-7033
Fax Number	:	704-544-7032

Provider Business Practice Location Address
First Line	:	7751 BALLANTYNE COMMONS PKWY
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2442
Country	:	US
Telephone Number	:	704-544-7033
Fax Number	:	704-544-7032

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/31/2010

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