Provider Demographics
NPI:1063809804
Name:HAYASHIBARA, SHANNON MIYUKI (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MIYUKI
Last Name:HAYASHIBARA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 LAS POSITAS CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-8872
Mailing Address - Country:US
Mailing Address - Phone:360-951-3378
Mailing Address - Fax:
Practice Address - Street 1:2177 LAS POSITAS CT
Practice Address - Street 2:SUITE E
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-8872
Practice Address - Country:US
Practice Address - Phone:360-951-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics