MEDICARE: SHANNON D DANG 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	1223G0001X	General Practice Dentistry	47066	CA

General Provider Information

NPI Number	:	1457402695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON D DANG DDS

Provider Business Mailing Address
First Line	:	2735 DEL PASO RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2319
Country	:	US
Telephone Number	:	916-263-9724
Fax Number	:	916-263-9736

Provider Business Practice Location Address
First Line	:	2735 DEL PASO RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2319
Country	:	US
Telephone Number	:	916-263-9724
Fax Number	:	916-263-9736

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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